Indian Journal of Respiratory Care

IJRC Email      Register      Login

VOLUME 6 , ISSUE 2 ( July-December, 2017 ) > List of Articles

Original Article

A Prospective Observational Study to Evaluate the Severity Assessment Scores in Community-acquired Pneumonia for Adult Patients

Akhila Babu, Nybin Jose, Jona Jose

Keywords : Community-acquired infections/diagnosis, pneumonia, severity of illness index

Citation Information : Babu A, Jose N, Jose J. A Prospective Observational Study to Evaluate the Severity Assessment Scores in Community-acquired Pneumonia for Adult Patients. Indian J Respir Care 2017; 6 (2):820-823.

DOI: 10.4103/ijrc.ijrc_16_17

License: CC BY-NC-SA 3.0

Published Online: 02-12-2022

Copyright Statement:  Copyright © 2017; Indian Journal of Respiratory Care.


Abstract

Introduction: Assessment of severity is the first step for determining whether a patient diagnosed with community-acquired pneumonia (CAP) needs to be admitted to the hospital or can be treated on outpatient basis. Aim: This study compares the ability of three severity scoring systems, systolic blood pressure, multilobar chest radiography involvement, albumin level, respiratory rate, tachycardia, confusion, oxygenation, and arterial pH (SMART-COP), confusion, urea nitrogen, respiratory rate, blood pressure less than 90/60 mm Hg and age over 65 years (CURB-65), and pneumonia severity index (PSI) to predict the need for mechanical ventilation and inotropic support among adult patients admitted to the hospital. Methodology: This was an observational study conducted on patients admitted from March 2016 to July 2016 to the Intensive Care Unit (ICU). Demographic data, severity scores from CURB-65, PSI, and SMART-COP, were documented. Patients were followed up for the need for mechanical ventilatory/inotropic support. The overall mortality of patients with CAP was recorded. Results: A total of eighty patients with CAP were included in this study. Forty-seven (59%) were male. A CURB-65 severity score ≥2 had a sensitivity, specificity, and negative predictive value (NPV) of 85.7%, 47.5%, and 9.7%, respectively, for ICU admission. For a PSI severity score ≥4, the sensitivity, specificity, and NPV were 71.4%, 46.8%, and 18.6%. SMART-COP severity score >3 had a sensitivity, specificity, and NPV of 85.7%, 62.4%, and 20.7%, respectively. In predicting inotropic support, CURB-65 (PSI, SMART-COP) had sensitivity of 85.4% (80.5%, 90.2%), specificity of 64.1% (64.1%, 81.5%) and NPV of 19.4% (24.2%, 28.8%). Conclusions: SMART-COP scoring system is superior to CURB-65 and PSI in predicting the need for mechanical ventilation and inotropic support.


HTML PDF Share
  1. Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, et al. BTS guidelines for the management of community acquired pneumonia in adults: Update 2009. Thorax 2009;64 Suppl 3:iii1-55.
  2. Marrie TJ, Poulin-Costello M, Beecroft MD, Herman-Gnjidic Z. Etiology of community-acquired pneumonia treated in an ambulatory setting. Respir Med 2005;99:60-5.
  3. Marik PE. The clinical features of severe community-acquired pneumonia presenting as septic shock. Norasept II Study Investigators. J Crit Care 2000;15:85-90.
  4. Menon RU, George AP, Menon UK. Etiology and Anti-microbial sensitivity of organisms causing community acquired pneumonia: A single hospital study. J Family Med Prim Care 2013;2:244-9.
  5. Shah BA, Singh G, Naik MA, Dhobi GN. Bacteriological and clinical profile of Community acquired pneumonia in hospitalized patients. Lung India 2010;27:54-7.
  6. Community-acquired pneumonia in adults in British hospitals in 1982-1983: A survey of aetiology, mortality, prognostic factors and outcome. The British Thoracic Society and the Public Health Laboratory Service. Q J Med 1987;62:195-220.
  7. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-50.
  8. Charles PG, Wolfe R, Whitby M, Fine MJ, Fuller AJ, Stirling R, et al. SMART-COP: A tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis 2008;47:375-84.
  9. Chalmers JD, Singanayagam A, Hill AT. Predicting the need for mechanical ventilation and/or inotropic support for young adults admitted to the hospital with community-acquired pneumonia. Clin Infect Dis 2008;47:1571-4.
  10. Shah BA, Ahmed W, Dhobi GN, Shah NN, Khursheed SQ, Haq I. Validity of pneumonia severity index and CURB-65 severity scoring systems in community acquired pneumonia in an Indian setting. Indian J Chest Dis Allied Sci 2010;52:9-17.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.