Predictive value of different severity scoring systems in patients with community acquired pneumonia

Background
For patients with community-acquired pneumonia (CAP), determining the severity and location of care is essential for ensuring their safety and apportion of resources appropriately. Severity scores can help clinicians fortell the outcome of patients having CAP.
This study aimed to compare different scoring systems of CAP in predicting mortality, Intensive Care Unit (ICU) admission, mechanical ventilation, and the need for vasopressors.


Methods
This was a prospective cohort study carried out at Benha University Hospitals from March 2022 to March 2023 on 60 patients aged above 18 years (58 ± 16) presented by CAP. Scores for assessment were the pneumonia severity index (PSI), CURB-65, CORB, CRSI-65, SCAP, and SMART COP scoring systems.


Results
Higher severity scores were associated with increased mortality, ICU admission, and Intensive Respiratory and Vasopressor Support (IRVS). SMART COP was the best score with AUC 0.750 (95% CI: 0.577–0.923) for ICU admission prediction (cut-off >2, sensitivity 83.3%, P=0.008). SCAP score was the best score with AUC 0.710 (95% CI: 0.579–0.820) for mortality prediction. CORB score (AUC 0.674, cut-off >1, sensitivity 80.00%, P=0.015) and Severe Community Acquired Pneumonia score (SCAP score) (AUC 0.711, cut-off >21, sensitivity 80.00%, P=0.002) were most sensitive in predicted vasopressor use. PSI score was the most sensitive AUC 0.727 (95% CI: 0.597–0.834) for Mechanical Ventilation (MV) use (cut-off >115, sensitivity 94.10%, P=0.001).


Conclusion
Severity scoring systems, including PSI, CURB-65, CORB, CRSI 65, SCAP, and SMART COP, are valuable tools for predicting the severity, mortality, ICU admission, and the need for MV and vasopressors in patients with CAP. SCAP score was the most valuable.