Community-acquired pneumonia: comparison of three mortality prediction scores in the emergency department

BACKGROUND: qSOFA is a score to identify patients with suspected infection and risk of complications. Its criteria are like those evaluated in prognostic scores for pneumonia (CRB-65 - CURB-65), but it is not clear which is best for predicting mortality and admission to the ICU. OBJECTIVE: Compare three scores (CURB-65, CRB-65 and qSOFA) to determine the best tool to identify emergency department patients with pneumonia at increased risk of mortality or intensive care unit (ICU) admission. METHODS: Secondary analysis of three prospective cohorts of patients hospitalized with diagnosis of pneumonia in five Colombian hospitals. Validation and comparison of the score´s accuracies were performed by means of discrimination and calibration measures. RESULTS: Cohorts 1, 2 and 3 included 158, 745 and 207 patients, with mortality rates of 32.3%, 17.2% and 18.4%, and admission to ICU was required for 52.5%, 43.5% and 25.6%, respectively. The best AUC-ROC for mortality was for CURB-65 in cohort 3 (AUC-ROC=0.67). The calibration was adequate (p>0.05) for the three scores. CONCLUSIONS: None of these scores proved to be an appropriate predictor for mortality and admission to the ICU. Furthermore, the CRB 65 exhibited the lowest discriminative ability.