The value of scoring systems in predicting respiratory intensive care unit admission and 30-day mortality in hospitalized community-acquired pneumonia: A prospective study

This study aims to compare the predictive performance of 5 commonly used severity scoring systems, pneumonia severity index (PSI), SMART-COP, Infectious Diseases Society of America and American Thoracic Society (IDSA/ATS) 2007 minor criteria, simplified minor criteria, and modified minor criteria, in identifying 30-day all-cause mortality and the need for respiratory intensive care unit (RICU) admission among hospitalized patients with community-acquired pneumonia (CAP) in Vietnam. This prospective study was conducted at the Department of Pulmonary Medicine, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, from October 2019 to May 2020. We enrolled 101 hospitalized patients with CAP based on clinical and radiographic criteria. Multiple clinical scoring systems (PSI, SMART-COP, IDSA/ATS 2007, simplified and modified versions) were applied to assess 30-day all-cause mortality and RICU needs. Receiver operating characteristic curve analysis was used to evaluate the discriminatory ability of different scoring systems in predicting RICU admission and 30-day all-cause mortality. The area under the receiver operating characteristic curve (AUC) and P-values were calculated for each score. A total of 101 hospitalized patients were included, with a median age of 72. Common symptoms were productive cough, dyspnea, and fever (about 80%). Those admitted to RICU had a significantly higher prevalence of cerebrovascular disease, cognitive impairment, respiratory rates ≥ 30 bpm, and systolic blood pressure < 90 mm Hg, as well as worse laboratory findings, including elevated creatinine, blood urea nitrogen ≥ 7 mmol/L, hypoalbuminemia, multilobar chest radiographic involvement, and PaO2/FiO2 ratio ≤ 250. Overall, 29.7% of patients died within 30 days. Non-survivors had a significantly higher prevalence of cerebrovascular disease, cognitive impairment, respiratory rates ≥ 30 bpm, blood urea nitrogen ≥ 7 mmol/L, and PaO2/FiO2 ratio ≤ 250. IDSA/ATS 2007 minor criteria had the highest AUC for RICU prediction (0.815), while PSI best predicted 30-day mortality (AUC = 0.774). PSI score demonstrated the highest accuracy in predicting 30-day all-cause mortality among hospitalized patients with CAP. Meanwhile, IDSA/ATS 2007 minor criteria were most effective in predicting RICU admission.