Prospective cohort study in a general ICU in Brazil. ICU severity scores (SAPS 3 and qSOFA), prognostic scores of pneumonia (CURB-65 and CRB-65), clinical and epidemiological variables in the first 6 hours of hospitalization were analyzed.
A total of 200 patients were included between August 2015 and July 2018 with a median age of 81 years (IQR 67-90) and female predominance (52%) primarily admitted from the emergency department (65%) with community acquired pneumonia (80.5%). Poor discriminative performance in predicting mortality was found with SAPS 3, CURB-65, CRB-65 and qSOFA. Multivariate regression identified variables independently associated with mortality that were used to develop a novel pneumonia specific ICU severity score (Pneumonia SHOCK score) that outperformed SAPS3, CURB-65 and CRB-65 (AUC 0.80 vs 0.74, 0.65 and 0.63, respectively). Discriminate function of the Pneumonia SHOCK score was validated in an external multi-center cohort of critically ill patients admitted with community acquired pneumonia (AUC 0.81).
We created a parsimonious score system that accurately identifies elderly and non-elderly patients with pneumonia at highest risk of ICU death. These findings are critical to accurately stratify patients with severe pneumonia in therapeutic trials that aim to reduce pneumonia mortality.
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