Which is smarter- SMART-COP or procalcitonin?

<bold>Objective:</bold> We aimed to find out if the SMART-COP score and procalcitonin (PCT) levels can reliably predict patient outcomes and need for intensive (intensive vasopressor and respiratory support-IVRS) care in patients admitted with community-acquired pneumonia (CAP). <bold>Methods:</bold> 101 patients diagnosed with CAP were recruited for cross-sectional analysis using consecutive sampling. Patients with non-infectious etiology or concomitant extra-pulmonary infections were excluded. Stratification into risk-categories was done according to SMART-COP scores. The PCT levels were determined by semi-quantitative solid-phase immunoassay. For normality of data, the Shapiro-Wilk test was applied. The chi-square and Fischer’s exact tests were used to assess the association between SMART-COP/PCT categories and outcomes (in-hospital mortality/discharge) and need for IVRS. <bold>Results:</bold> Of the cohort, nearly half (n=50) were high or very-high risk according to the SMART-COP score. 70 patients (69.3%) had high/very high PCT levels. 55.4% (n=56) patients needed vasopressor support and 39.6% (n=40) required intensive respiratory therapy (IRT). We found statistically significant association of the SMART-COP score with both vasopressor use (p= 0.001) and need for IRT (p= 0.001). Apart from this, the SMART-COP score was also positively linked with PCT levels (p=0.008) and patient outcome (p= 0.001). In contrast, procalcitonin levels demonstrated statistical significance with SMART-COP score (p=0.008) and vasopressor use (0.001) only. <bold>Conclusion:</bold> Preferential use of the SMART-COP score over a costly test like procalcitonin can facilitate doctors and patients in resource-poor countries like ours by accurately flagging patients who may require intensive care