A Prospective Observational Study to Evaluate the Severity Assessment Scores in Community-acquired Pneumonia for Adult Patients

Abstract

Introduction: Assessment of severity is the first step for determining whether a patient diagnosed with community-acquired pneumonia (CAP) needs to be admitted to the hospital or can be treated on outpatient basis. Aim: This study compares the ability of three severity scoring systems, systolic blood pressure, multilobar chest radiography involvement, albumin level, respiratory rate, tachycardia, confusion, oxygenation, and arterial pH (SMART-COP), confusion, urea nitrogen, respiratory rate, blood pressure less than 90/60 mm Hg and age over 65 years (CURB-65), and pneumonia severity index (PSI) to predict the need for mechanical ventilation and inotropic support among adult patients admitted to the hospital. Methodology: This was an observational study conducted on patients admitted from March 2016 to July 2016 to the Intensive Care Unit (ICU). Demographic data, severity scores from CURB-65, PSI, and SMART-COP, were documented. Patients were followed up for the need for mechanical ventilatory/inotropic support. The overall mortality of patients with CAP was recorded. Results: A total of eighty patients with CAP were included in this study. Forty-seven (59%) were male. A CURB-65 severity score ≥2 had a sensitivity, specificity, and negative predictive value (NPV) of 85.7%, 47.5%, and 9.7%, respectively, for ICU admission. For a PSI severity score ≥4, the sensitivity, specificity, and NPV were 71.4%, 46.8%, and 18.6%. SMART-COP severity score >3 had a sensitivity, specificity, and NPV of 85.7%, 62.4%, and 20.7%, respectively. In predicting inotropic support, CURB-65 (PSI, SMART-COP) had sensitivity of 85.4% (80.5%, 90.2%), specificity of 64.1% (64.1%, 81.5%) and NPV of 19.4% (24.2%, 28.8%). Conclusions: SMART-COP scoring system is superior to CURB-65 and PSI in predicting the need for mechanical ventilation and inotropic support.