Validation and comparison of three mortality prediction scores in emergency department patients with community-acquired pneumonia

Abstract

Background: qSOFA is a score to identify patients with suspected infection and risk of complications. Its criteria are similar to those evaluated in prognostic scores for pneumonia (CRB-65 - CURB-65), but it is not clear which is best for predicting mortality and admission to the ICU.

Objective: validate and compare three scores (CURB-65, CRB-65 and qSOFA) to determine the best tool to identify emergency department patients with pneumonia who are at increased risk of mortality or intensive care unit (ICU) admission.

Methods: Secondary analysis of three prospective cohorts of patients hospitalized with diagnosis of pneumonia in five hospitals in Medellin (Colombia). Validation and comparison of the score´s accuracies were performed by means of discrimination and calibration measures.

Results: Cohorts 1, 2 and 3 included 158, 745 and 207 patients, with mortality rates of 32.3%, 17.2% and 18.4%, and admission to ICU was required for 52.5%, 43.5% and 25.6%, respectively. The best AUC-ROC for mortality was for CURB-65 in cohort 3 (AUC-ROC=0.67). The calibration was adequate (p>0.05) for the three scores.

Conclusions: None of these scores proved to be an appropriate predictor for mortality and admission to the ICU. It is probable that the local context have modified their performance. It is necessary to validate the old ones and probably to develop new predictive models of prognosis for CAP in each country.