by Peter Ahnert, Petra Creutz, Katrin Horn, Fabian
Schwarzenberger, Michael Kiehntopf, Hamid Hossain, Michael Bauer, Frank Martin
Brunkhorst, Konrad Reinhart, Uwe Völker, Trinad Chakraborty, Martin Witzenrath,
Markus Löffler, Norbert Suttorp and Markus Scholz
Critical Care: 201923:110
Background: CAP
(Community acquired pneumonia) is frequent, with a high mortality rate and a
high burden on health care systems. Development of predictive biomarkers, new
therapeutic concepts, and epidemiologic research require a valid, reproducible,
and quantitative measure describing CAP severity.
Methods: Using
time series data of 1532 patients enrolled in the PROGRESS study, we compared
putative measures of CAP severity for their utility as an operationalization.
Comparison was based on ability to correctly identify patients with an
objectively severe state of disease (death or need for intensive care with at
least one of the following: substantial respiratory support, treatment with
catecholamines, or dialysis). We considered IDSA/ATS minor criteria, CRB-65,
CURB-65, Halm criteria, qSOFA, PSI, SCAP, SIRS-Score, SMART-COP, and SOFA.
Results: SOFA significantly outperformed other scores in
correctly identifying a severe state of disease at the day of enrollment
(AUC = 0.948), mainly caused by higher discriminative power at higher score
values. Runners-up were the sum of IDSA/ATS minor criteria (AUC = 0.916) and
SCAP (AUC = 0.868). SOFA performed similarly well on subsequent study days (all
AUC > 0.9) and across age groups. In univariate and multivariate analysis,
age, sex, and pack-years significantly contributed to higher SOFA values
whereas antibiosis before hospitalization predicted lower SOFA.
Conclusions: SOFA
score can serve as an excellent operationalization of CAP severity and is
proposed as endpoint for biomarker and therapeutic studies.
Trial
registration
clinicaltrials.gov NCT02782013,
May 25, 2016, retrospectively registered.
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