Clinical Interventions in Aging (Oct 2021)
Comparison of Different Scoring Systems for Prediction of Mortality and ICU Admission in Elderly CAP Population
Abstract
Chunxin Lv,1,* Yue Chen,2,* Wen Shi,3 Teng Pan,4 Jinhai Deng,5 Jiayi Xu6 1Oncology Department, Punan Hospital of Pudong New District, Shanghai, People’s Republic of China; 2Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, London, EC1M 6BE, UK; 3Department of Dermatology, Punan Hospital of Pudong New District, Shanghai, People’s Republic of China; 4Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People’s Republic of China; 5Key Laboratory of Medical Immunology, Department of Immunology, Peking University Center for Human Disease Genomics, Ministry of Health, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People’s Republic of China; 6Geriatric Department, Fudan University, Minhang Hospital, Shanghai, 201100, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jinhai DengKey Laboratory of Medical Immunology, Department of Immunology, Peking University Center for Human Disease Genomics, Ministry of Health, School of Basic Medical Sciences, Peking University Health Science Center, No. 38, Xueyuan Road, Beijing, People’s Republic of ChinaEmail [email protected] XuGeriatric Department, Fudan University, Minhang Hospital, No. 170, Xinsong Road, Shanghai, 201100, People’s Republic of ChinaTel +86-021-64923400Email [email protected]: The incidence and mortality rate of community-acquired pneumonia (CAP) in elderly patients were higher than the younger population. Different scoring systems, including The quick Sequential Organ Function Assessment (qSOFA), Combination of Confusion, Urea, Respiratory Rate, Blood Pressure, and Age ≥ 65 (CURB-65), Modified Early Warning Score (MEWS) and National Early Warning Score (NEWS), were used widely for predicting mortality and ICU admission of patients with community-acquired pneumonia (CAP). This study aimed to identify the most suitable score system for better hospitalization.Methods: We retrospectively analyzed elderly patients with CAP in Minhang Hospital, Fudan University from 1 January 2018 to 1 January 2020. We recorded information of the patients including age, gender, underlying disease, consciousness state, vital signs, physiological and laboratory variables and further calculated the qSOFA, CURB-65, MEWS, and NEWS scores. Receiver operating characteristic (ROC) curves were used to predict the mortality risk and ICU admission. Kaplan–Meier survival curves were used in survival rate.Results: In total, 1044 patients were selected for analysis and divided into two groups, namely survivor groups (902 cases) and non-survivor groups (142 cases). Depending on ICU admission enrolled patients were classified into ICU admission (n = 102) and non-ICU admission (n = 942) groups. Mortality expressed as AUC values were 0.844 (p < 0.001), 0.868 (p < 0.001), 0.927 (p < 0.001) and 0.892 (p < 0.001) for qSOFA, CURB 65, MEWS and NEWS, respectively. There were clear differences in MEWS vs CURB-65 (p < 0.0001), MEWS vs NEWS (p < 0.001), MEWS vs qSOFA (p < 0.0001). For ICU-admission, the AUC values of qSOFA, CURB-65, MEWS and NEWS scores were 0.866 (p < 0.001), 0.854 (p < 0.001), 0.922 (p < 0.001), 0.976 (p < 0.001), respectively. There were significant differences in NEWS vs CURB-65 (p < 0.0001), NEWS vs MEWS (p < 0.001), NEWS vs qSOFA (p < 0.0001).Conclusion: We explored the outcome prediction values of CURB65, qSOFA, MEWS and NEWS for patients aged 65-years and older with community-acquired pneumonia. We found that MEWS showed superiority over the other severity scores in predicting hospital mortality, and NEWS showed superiority over the other scores in predicting ICU admission.Keywords: NEWS, MEWS, community-acquired pneumonia, prognosis
