Sequential organ failure assessment score is an excellent operationalization of disease severity of adult patients with hospitalized community acquired pneumonia – results from the prospective observational PROGRESS study
Peter Ahnert,
Petra Creutz,
Katrin Horn,
Fabian Schwarzenberger,
Michael Kiehntopf,
Hamid Hossain,
Michael Bauer,
Frank Martin Brunkhorst,
Konrad Reinhart,
Uwe Völker,
Trinad Chakraborty,
Martin Witzenrath,
Markus Löffler,
Norbert Suttorp,
Markus Scholz,
The PROGRESS Study Group
Affiliations
Peter Ahnert
University of Leipzig, Institute for Medical Informatics, Statistics and Epidemiology (IMISE)
Petra Creutz
Department of Infectious Disease and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
Katrin Horn
University of Leipzig, Institute for Medical Informatics, Statistics and Epidemiology (IMISE)
Fabian Schwarzenberger
Faculty of Informatics / Mathematics, HTW Dresden University of Applied Sciences
Michael Kiehntopf
Jena University Hospital, Integrated Biobank Jena (IBBJ) and Institute of Clinical Chemistry and Laboratory Diagnostics
Hamid Hossain
Technische Hochschule Mittelhessen, University of Applied Sciences, Life Science Engineering
Michael Bauer
Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital
Frank Martin Brunkhorst
Center for Clinical Studies and Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital
Konrad Reinhart
Jena University Hospital
Uwe Völker
Department Functional Genomics, Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald
Trinad Chakraborty
University Hospital Giessen, Institute for Medical Microbiology
Martin Witzenrath
Department of Infectious Disease and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
Markus Löffler
Department of Infectious Disease and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
Norbert Suttorp
Department of Infectious Disease and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
Markus Scholz
University of Leipzig, Institute for Medical Informatics, Statistics and Epidemiology (IMISE)
The PROGRESS Study Group
Department of Infectious Disease and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
Abstract Background CAP (Community acquired pneumonia) is frequent, with a high mortality rate and a high burden on health care systems. Development of predictive biomarkers, new therapeutic concepts, and epidemiologic research require a valid, reproducible, and quantitative measure describing CAP severity. Methods Using time series data of 1532 patients enrolled in the PROGRESS study, we compared putative measures of CAP severity for their utility as an operationalization. Comparison was based on ability to correctly identify patients with an objectively severe state of disease (death or need for intensive care with at least one of the following: substantial respiratory support, treatment with catecholamines, or dialysis). We considered IDSA/ATS minor criteria, CRB-65, CURB-65, Halm criteria, qSOFA, PSI, SCAP, SIRS-Score, SMART-COP, and SOFA. Results SOFA significantly outperformed other scores in correctly identifying a severe state of disease at the day of enrollment (AUC = 0.948), mainly caused by higher discriminative power at higher score values. Runners-up were the sum of IDSA/ATS minor criteria (AUC = 0.916) and SCAP (AUC = 0.868). SOFA performed similarly well on subsequent study days (all AUC > 0.9) and across age groups. In univariate and multivariate analysis, age, sex, and pack-years significantly contributed to higher SOFA values whereas antibiosis before hospitalization predicted lower SOFA. Conclusions SOFA score can serve as an excellent operationalization of CAP severity and is proposed as endpoint for biomarker and therapeutic studies. Trial registration clinicaltrials.gov NCT02782013, May 25, 2016, retrospectively registered.
