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Colombia Médica
On-line version ISSN 1657-9534
Abstract
HINCAPIE, Carolina; ASCUNTAR, Johana; LEON, Alba and JAIMES, Fabián. Community-acquired pneumonia: comparison of three mortality prediction scores in the emergency department. Colomb. Med. [online]. 2021, vol.52, n.4, e2044287. Epub Oct 23, 2021. ISSN 1657-9534. https://doi.org/10.25100/cm.v52i4.4287.
Background:
qSOFA is a score to identify patients with suspected infection and risk of complications. Its criteria are like 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:
Compare three scores (CURB-65, CRB-65 and qSOFA) to determine the best tool to identify emergency department patients with pneumonia 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 Colombian hospitals. 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. Furthermore, the CRB 65 exhibited the lowest discriminative ability.
Keywords : Sepsis; pneumonia; clinical decision rules; mortality.