Severity assessment in melioidosis pneumonia: validity of PSI, CURB-65, and SMART-COP scoring criteria

Background: Pneumonia is a common clinical presentation of Burkholderia pseudomallei infection. Along with the development of melioidosis rapid diagnostic tests, prognostic assessment [including prediction of intensive respiratory or vasopressor support (IRVS) need and death outcome] for melioidosis pneumonia (MP) patients at admission is essential. Study to compare pneumonia scoring systems, likewise the mortality scoring system for acute melioidosis, among MP patients is still lacking. This study aims to evaluate the validity of these scores in predicting MP patients. Methods: A prospective cross-sectional study was conducted from October 2019 to February 2022 at the Respiratory Department of Cho Ray’s Hospital, Ho Chi Minh, Vietnam (the largest central hospital in Southern Vietnam). All adult MP patients hospitalized with a medical history ≤2 months were enrolled conveniently and consecutively. Pneumonia severity index (PSI), CURB-65 (acronym for confusion, urea, respiratory rate, blood pressure and age ≥65 years), and SMART-COP (acronym for systolic blood pressure, multilobar infiltrates, albumin, respiratory rate, tachycardia, confusion, oxygen and pH) as well as the acute melioidosis mortality scoring system were evaluated. Results: Of 66 MP patients, mean age was 51±11 years, and male gender accounted for 86.4% (57/66). Patients requiring IRVS constituted 34.8% (23/66) and the mortality rate at discharged was 25.8% (17/66). The areas under receiver operating characteristic curve (AUCs) of PSI, CURB-65, and SMART-COP in predicting the IRVS need were 0.813 [95% confidence interval (CI): 0.684–0.943, P<0.001], 0.868 (95% CI: 0.767–0.969, P<0.001), and 0.910 (95% CI: 0.825–0.994, P<0.001), respectively. The AUCs of PSI, CURB-65, SMART-COP, and the mortality score of acute melioidosis in predicting the death outcome were 0.698 (95% CI: 0.536–0.857, P=0.02), 0.797 (95% CI: 0.665–0.928, P<0.001), 0.797 (95% CI: 0.673–0.920, P<0.001), and 0.663 (95% CI: 0.524–0.801, P=0.05), respectively. CURB-65 score is non-inferior to SMART-COP in predicting MP patients. The sensitivity, specificity, and positive likelihood ratio for CURB-65 score ≥2 in predicting the IRVS need were 69.57%, 90.70%, and 7.48, respectively and in predicting the mortality 70.59%, 83.67%, and 11.53, respectively. Conclusions: MP could present mild to severe clinical scenario, with higher mortality in severe MP cases. The CURB-65 score could be simple and useful in predicting the IRVS need or the death outcome among MP patients.