Quick Sequential Organ Failure Assessment (qSOFA) and Performance Status Scoring Systems as Prognostic Predictors in Pneumococcal Community-Acquired Pneumonia

Background and aim <i>Streptococcus pneumoniae</i>, or pneumococcus, is one of the most common pathogens responsible for community-acquired pneumonia (CAP), which can progress to sepsis and lead to severe illness. Several clinical scoring systems are widely used to assess the severity of CAP and sepsis. This study aims to evaluate the clinical factors that predict mortality in pneumococcal CAP (pCAP). Methods Patients eligible for this study were 16 years or older and diagnosed with pCAP at Yamagata Prefectural Central Hospital, Yamagata, Japan, between January 2012 and May 2018. pCAP was defined by the single isolation of <i>S. pneumoniae</i> from sputum or blood culture in patients with CAP. Patients were divided into two groups based on 60-day mortality: survivors and non-survivors. Clinical parameters, including performance status (PS), were assessed for both groups. Disease severity was evaluated using the A-DROP, CURB-65, and quick Sequential Organ Failure Assessment (qSOFA) scores. Statistical analysis was performed using JMP 11 software (JMP Statistical Discovery LLC, NC, USA). Results A total of 192 patients (135 men and 57 women) were enrolled in this study. The median age was 77 years (range: 21-97 years). Among them, 169 patients were survivors and 22 were non-survivors. <i>S. pneumoniae</i> was more frequently detected in the blood cultures of non-survivors than survivors (27.3% vs. 7.7%, respectively; p = 0.01, chi-square test). Non-survivors exhibited poorer PS (PS ≥3), higher A-DROP scores (A-DROP ≥3), and higher qSOFA scores (qSOFA ≥2) compared to survivors (p = 0.002, 0.02, and 0.0003, chi-square test, respectively). However, there was no significant difference in the CURB-65 score between the two groups. Multivariate analysis revealed that higher qSOFA scores and poor PS were independent risk factors for 60-day mortality in pCAP (OR 4.0 (95% CI: 1.3-13.3) and 4.0 (1.4-10.9), respectively). Conclusions The qSOFA and PS scoring systems may be useful in predicting the prognosis of pCAP.