Comparison of Pneumonia-specific Scores, Sepsis Score and Generic Score in Predicting the Severity of Community-acquired Pneumonia: A Cross-sectional Study

Abstract

Introduction: Pneumonia is defined as inflammation of the pulmonary parenchyma caused by an infectious agent. Community-acquired Pneumonia (CAP) is a heterogeneous disease with a significant disease burden, morbidity, and mortality. Severe Community-acquired Pneumonia (SCAP) has been proven to be associated with increased Intensive Care Unit (ICU) admission, mechanical ventilation, and mortality. Although several severity assessment tools are available, there is a lack of evidence to support one tool over another in patients with pneumonia. Aim: To compare the ability of pneumonia-specific scores {{Confusion, Urea, Respiratory rate, Blood pressure (CURB)-65 and Expanded CURB-65)}, Sepsis score {quick Sepsis-related Organ Failure Assessment (qSOFA)}, and Generic score {National Early Warning Score (NEWS)} in predicting SCAP patients at the time of hospital admission. Materials and Methods: This was a hospital-based cross-sectional study conducted in the Department of Pulmonary Medicine, Government Hospital for Chest and Communicable Diseases, Andhra Medical College, Visakhapatnam, India, on 100 patients with clinically and radiologically diagnosed CAP over a period of six months from April 2023 to September 2023 after obtaining Institutional ethics clearance and informed consent. All four severity scores (CURB-65, eCURB-65, qSOFA, NEWS) were documented in each patient at the time of admission. Outcomes such as 30-day mortality and ICU admission were measured. Receiver Operating Characteristic (ROC) curve analysis was performed for mortality prediction and ICU admission for all four scoring systems, and statistical analysis was carried out using Statistical Packages for Social Sciences (SPSS) version 24.0. Results: Out of 100 patients, 62 (62%) were males, and the remaining 38 (38%) were females with a mean age of 56±15 years. The number of patients with co-morbidities was 48 (48%). Regarding addictive habits, smoking and alcohol played a significant role at 38% and 33%, respectively. A 30-day mortality was observed in 18 (18%) patients, and 20 (20%) patients received ICU treatment. The frequency of patients with co-morbidities such as Diabetes Mellitus (DM), Hypertension (HTN), Ischaemic Heart Disease (IHD), and Chronic Obstructive Pulmonary Disease (COPD) was 21%, 33%, 5%, and 3%, respectively. For ICU admission as an outcome measure, the Area Under Receiver Operating Characteristics (AUROC) values were as follows: CURB-65: 0.977 (95% CI: 0.949-1.00, p-value <0.001); Expanded CURB-65: 0.966 (95% CI: 0.931-1.00, p-value <0.001); qSOFA: 0.935 (95% CI: 0.881-0.989, p-value <0.001); NEWS score: 0.967 (95% CI: 0.934-1.00, p-value <0.001). Conclusion: In the present study, all four scoring systems were equally effective in detecting the need for ICU admission and predicting 30-day mortality among CAP patients at the time of admission. However, organ-specific tools (CURB-65 (2-3) moderate) have demonstrated valid and effective means of assessing severity compared to sepsis scores and generic tools.

Keywords

• assessment
• mortality
• scoring
• ventilation