Prediction accuracy of commonly used pneumonia severity scores in Aboriginal patients with severe community-acquired pneumonia: a retrospective study

Danny Tsai, Paul Secombe, Fabian Chiong, Shahid Ullah, Jeffrey Lipman, Saliya Hewagama

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Assess the prediction accuracy of pneumonia severity scores in Aboriginal patients with severe community-acquired pneumonia (SCAP) and identify risk factors for poor prognosis. Methods: Retrospective cohort study examining Aboriginal patients admitted to intensive care unit (ICU) with confirmed SCAP between January 2011 and December 2014. Severity scores were calculated for SMARTCOP, SMARTACOP, CURB65, PSI, IDSA/ATS SCAP (IASCAP) and APACHE II/III scores using medical records. Prediction accuracy of 30-day mortality and requirement for intensive respiratory and/or vasoactive support (IRVS) were assessed using logistic regression and the area under the receiver operating characteristic curve (AUROC). Multivariate analysis was used to test associations between poor prognosis and demographic/clinical variables. Results: A total of 203 cases were identified (49% female). Thirty-day mortality was 6.4% (n=13) and 53% (n=107) required IRVS. None of the tested pneumonia severity scores accurately predicted mortality. SMARTCOP and SMARTACOP predicted IRVS requirement with the highest diagnostic accuracy, but only achieved acceptable discrimination (p=<0.001, <0.001; AUROC=0.74, 0.75, respectively). APACHE II/III predicted both mortality (p=0.003, 0.001; AUROC=0.74, 0.73, respectively) and IRVS requirement (p=<0.001, <0.001; AUROC=0.72, 0.73, respectively). Multivariate analysis associated mortality with male gender, cirrhosis, immunosuppression and acidaemia, and IRVS requirement with multi-lobar pneumonia, hypotension and tachypnoea. Multivariate analysis for mortality and IRVS requirement achieved an AUROC of 0.93 and 0.87, respectively. Conclusion: None of the pneumonia severity scores accurately predicted mortality. We recommend SMARTACOP to predict IRVS requirement in Aboriginal patients with SCAP. Given Aboriginal patients are over-represented in Australian ICUs, a new score is warranted for this understudied population.
Original languageEnglish
Number of pages22
JournalInternal Medicine Journal
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • Severe community acquired pneumonia
  • pneumonia
  • Indigenous Health
  • Aboriginal health
  • rural health
  • remote health

Fingerprint

Dive into the research topics of 'Prediction accuracy of commonly used pneumonia severity scores in Aboriginal patients with severe community-acquired pneumonia: a retrospective study'. Together they form a unique fingerprint.

Cite this