Prognostic value of clinical scoring systems and coagulation parameters in severe community aquired pneumonia

Abstract

Introduction Predicting ICU outcome in community-acquired pneumonia (CAP) is important for effective clinical decision making. CAP is associated with coagulation abnormalities even in patients with nonsevere illness, and these parameters may improve the ability of simple clinical scores to expect mortality in severe CAP. Patients and methods A prospective study was conducted on 100 patients with a primary diagnosis of CAP and who needed admission to ICU Minia University Hospital between the period of September 2018 and October 2019. The study aimed to evaluate the value of clinical scoring systems and coagulation parameters to predict prognosis of severe CAP. Results The overall ICU mortality was 41%. Following multivariable regression, male sex, Simplified Acute Physiological Score II score, diagnosis of cancer, and prothrombin time (PT) were significantly associated with ICU mortality. Apart from Acute Physiologic Assessment and Chronic Health Evaluation III score, all other severity scores, including the CURB-65 score, can differentiate between ICU survivors and nonsurvivors when calculated at the time of admission to ICU (P<0.0001). Allocating an extra point for PT more than 17 s to the CURB-65 score improved its sensitivity. Conclusion Mortality from severe CAP remains high. The ability of the CURB-65 score to differentiate between survivors and nonsurvivors of severe CAP is comparable to other more complex scores. Addition of PT may further improve its discriminatory ability.

Keywords

• clinical scoring
• coagulation parameters
• pneumonia