Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China.
National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Clinical Research and Data Management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
Clin Microbiol Infect. 2024 Nov;30(11):1426-1432. doi: 10.1016/j.cmi.2024.07.008. Epub 2024 Jul 14.
We aimed to assess the performance of common pneumonia severity scores, such as pneumonia severity index (PSI), CURB-65, CRB-65, A-DROP, and SMART-COP, in predicting adverse outcomes in elderly community-acquired pneumonia cohort and to determine the optimal scoring system for specific outcomes of interest.
A total of 822 elderly inpatients were included in the retrospective cohort study. Clinical and laboratory results on admission were used to calculate the above scores. The primary outcome was 30-day mortality. Secondary outcomes were in-hospital mortality, need for mechanical ventilation (MV) and ICU admission. Model discrimination was evaluated by the area under receiver operating characteristic curves (AUCs).
The 30-day and in-hospital mortality rates were 6.8% (56/822) and 8.6% (71/822), respectively. One hundred and ninety-eight (24.0%) received MV and 111 (13.5%) were admitted to the ICU. All five scoring systems showed the same trend of increasing rates of each adverse outcome with increasing risk groups (all p < 0.001). PSI had the highest AUC, sensitivity, and negative predictive value (NPV) in predicting 30-day mortality and in-hospital mortality. SMART-COP had the highest AUC for predicting the need for MV and ICU admission, but PSI had the highest sensitivity and NPV for these two outcomes.
PSI performed well in identifying elderly patients at risk for 30-day mortality and its high NPV is helpful in excluding patients who are not at risk. Considering their effectiveness and simplicity, SMART-COP and CURB-65 are easier to perform in clinical practice than PSI.
评估常用肺炎严重程度评分，如肺炎严重指数（PSI）、CURB-65、CRB-65、A-DROP 和 SMART-COP，在预测老年社区获得性肺炎患者不良预后中的表现，并确定针对特定感兴趣结局的最佳评分系统。
本回顾性队列研究共纳入 822 例老年住院患者。入院时的临床和实验室结果用于计算上述评分。主要结局为 30 天死亡率。次要结局为住院死亡率、需要机械通气（MV）和 ICU 入院。通过受试者工作特征曲线（ROC）下面积（AUCs）评估模型区分度。
30 天和住院死亡率分别为 6.8%（56/822）和 8.6%（71/822）。198 例（24.0%）接受 MV，111 例（13.5%）收入 ICU。所有 5 种评分系统均显示，随着风险组增加，各不良结局的发生率呈相同趋势（均 P<0.001）。PSI 在预测 30 天和住院死亡率方面具有最高的 AUC、敏感性和阴性预测值（NPV）。SMART-COP 在预测 MV 和 ICU 入院方面具有最高的 AUC，但 PSI 在这两个结局方面具有最高的敏感性和 NPV。
PSI 能很好地识别出 30 天内死亡风险高的老年患者，其高 NPV 有助于排除无风险患者。考虑到其有效性和简单性，SMART-COP 和 CURB-65 在临床实践中比 PSI 更容易实施。
