A prediction rule for severe adverse events in all inpatients with community-acquired pneumonia: a multicenter observational study

• Published in: BMC pulmonary medicine Vol. 22; no. 1; p. 34
• Main Authors: Sakakibara, Toshihiro, Shindo, Yuichiro, Kobayashi, Daisuke, Sano, Masahiro, Okumura, Junya, Murakami, Yasushi, Takahashi, Kunihiko, Matsui, Shigeyuki, Yagi, Tetsuya, Saka, Hideo, Hasegawa, Yoshinori
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12-01-2022; BioMed Central; BMC
• Subjects: Adult; Aged; Bacterial pneumonia; Blood diseases; Blood pressure; Care and treatment; Clinical Decision Rules; Community-acquired infections; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Datasets; Decision making; Development and progression; Ethics; Female; Healthcare-associated pneumonia; Hospital patients; Hospitals; Humans; Inpatients; Japan - epidemiology; Lung diseases; Male; Mechanical ventilation; Middle Aged; Mortality; Multivariate Analysis; Observational studies; Patient outcomes; Patients; Pleural effusion; Pneumonia; Pneumonia - epidemiology; Prediction models; Prediction score; Prevention; Pulmonology; Regression analysis; Respiration; Risk Assessment - methods; Risk Factors; Severe pneumonia; Severity; Severity of Illness Index; Variables; Young Adult; Japan; United States > US; Severity; Severe pneumonia; Mortality; Healthcare-associated pneumonia; Prediction score
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/s12890-022-01819-0

Prediction of inpatients with community-acquired pneumonia (CAP) at high risk for severe adverse events (SAEs) requiring higher-intensity treatment is critical. However, evidence regarding prediction rules applicable to all patients with CAP including those with healthcare-associated pneumonia (HCAP) is limited. The objective of this study is to develop and validate a new prediction system for SAEs in inpatients with CAP.
Logistic regression analysis was performed in 1334 inpatients of a prospective multicenter study to develop a multivariate model predicting SAEs (death, requirement of mechanical ventilation, and vasopressor support within 30 days after diagnosis). The developed ALL-COP-SCORE rule based on the multivariate model was validated in 643 inpatients in another prospective multicenter study.
The ALL-COP SCORE rule included albumin (< 2 g/dL, 2 points; 2-3 g/dL, 1 point), white blood cell (< 4000 cells/μL, 3 points), chronic lung disease (1 point), confusion (2 points), PaO
/F
O
ratio (< 200 mmHg, 3 points; 200-300 mmHg, 1 point), potassium (≥ 5.0 mEq/L, 2 points), arterial pH (< 7.35, 2 points), systolic blood pressure (< 90 mmHg, 2 points), PaCO
(> 45 mmHg, 2 points), HCO
(< 20 mmol/L, 1 point), respiratory rate (≥ 30 breaths/min, 1 point), pleural effusion (1 point), and extent of chest radiographical infiltration in unilateral lung (> 2/3, 2 points; 1/2-2/3, 1 point). Patients with 4-5, 6-7, and ≥ 8 points had 17%, 35%, and 52% increase in the probability of SAEs, respectively, whereas the probability of SAEs was 3% in patients with ≤ 3 points. The ALL-COP SCORE rule exhibited a higher area under the receiver operating characteristic curve (0.85) compared with the other predictive models, and an ALL-COP SCORE threshold of ≥ 4 points exhibited 92% sensitivity and 60% specificity.
ALL-COP SCORE rule can be useful to predict SAEs and aid in decision-making on treatment intensity for all inpatients with CAP including those with HCAP. Higher-intensity treatment should be considered in patients with CAP and an ALL-COP SCORE threshold of ≥ 4 points.
This study was registered with the University Medical Information Network in Japan, registration numbers UMIN000003306 and UMIN000009837.