School of Medicine, Universidad de La Sabana. Km 7, Autonorte de Bogota, Chía, Cundinamarca, 250001, Colombia.
Master's Student in Epidemiology, Universidad de La Sabana, Chía, Colombia.
BMC Infect Dis. 2024 Sep 3;24(1):912. doi: 10.1186/s12879-024-09792-1.
Risk scores facilitate the assessment of mortality risk in patients with community-acquired pneumonia (CAP). Despite their utilities, there is a scarcity of evidence comparing the various RS simultaneously. This study aims to evaluate and compare multiple risk scores reported in the literature for predicting 30-day mortality in adult patients with CAP.
A retrospective cohort study on patients diagnosed with CAP was conducted across two hospitals in Colombia. The areas under receiver operating characteristic curves (ROC-curves) were calculated for the outcome of survival or death at 30 days using the scores obtained for each of the analyzed questionnaires.
A total of 7454 potentially eligible patients were included, with 4350 in the final analysis, of whom 15.2% (662/4350) died within 30 days. The average age was 65.4 years (SD: 21.31), and 59.5% (2563/4350) were male. Chronic kidney disease was 3.7% (9.2% vs. 5.5%; p < 0.001) (OR: 1.85) higher in subjects who died compared to those who survived. Among the patients who died, 33.2% (220/662) presented septic shock compared to 7.3% (271/3688) of the patients who survived (p < 0.001). The best performances at 30 days were shown by the following scores: PSI, SMART-COP and CURB 65 scores with the areas under ROC-curves of 0.83 (95% CI: 0.8-0.85), 0.75 (95% CI: 0.66-0.83), and 0.73 (95% CI: 0.71-0.76), respectively. The RS with the lowest performance was SIRS with the area under ROC-curve of 0.53 (95% CI: 0.51-0.56).
The PSI, SMART-COP and CURB 65, demonstrated the best diagnostic performances for predicting 30-day mortality in patients diagnosed with CAP. The burden of comorbidities and complications associated with CAP was higher in patients who died.
风险评分有助于评估社区获得性肺炎（CAP）患者的死亡风险。尽管它们具有实用性，但同时比较各种 RS 的证据很少。本研究旨在评估和比较文献中报告的多种风险评分，以预测成人 CAP 患者的 30 天死亡率。
在哥伦比亚的两家医院进行了一项诊断为 CAP 的患者回顾性队列研究。使用为每个分析问卷获得的评分，计算出生存或 30 天内死亡的结果的接受者操作特征曲线（ROC 曲线）下面积。
共有 7454 名潜在合格患者入选，最终分析了 4350 名患者，其中 15.2%（662/4350）在 30 天内死亡。平均年龄为 65.4 岁（标准差：21.31），59.5%（2563/4350）为男性。与存活者相比，死亡者的慢性肾脏病发病率高 3.7%（9.2%比 5.5%；p<0.001）（OR：1.85）。在死亡患者中，33.2%（220/662）出现感染性休克，而存活患者中只有 7.3%（271/3688）（p<0.001）。在 30 天内表现最佳的评分如下：PSI、SMART-COP 和 CURB 65 评分，ROC 曲线下面积分别为 0.83（95%CI：0.8-0.85）、0.75（95%CI：0.66-0.83）和 0.73（95%CI：0.71-0.76）。表现最差的 RS 是 SIRS，ROC 曲线下面积为 0.53（95%CI：0.51-0.56）。
PSI、SMART-COP 和 CURB 65 对预测 CAP 患者 30 天死亡率的诊断性能最佳。死亡患者的合并症和并发症负担更高。
