Photo Credit: EvgeniyShkolenko

The following is a summary of “Assessment of disease severity in hospitalized community-acquired pneumonia by the use of validated scoring systems,” published in the March 2025 issue of the BMC Pulmonary Medicine by Iftikhar and Waagsbø et al.

Accurate severity assessment of community-acquired pneumonia (CAP) is critical for guiding clinical decision-making, including microbiological confirmation strategies and the selection of appropriate empirical antimicrobial therapy. Numerous severity scoring systems have been developed to assist clinicians in predicting severe outcomes, yet their comparative performance remains an area of ongoing investigation. This study aimed to evaluate and compare the predictive accuracy of nine disease severity assessment scoring systems in a large CAP cohort from 2016 to 2021. The predictive capabilities of these systems were assessed using intra-hospital all-cause mortality and the need for intensive care unit (ICU) admission as primary outcomes. The area under the receiver operating characteristic (ROC) curve was utilized to quantify the diagnostic performance of each scoring system.

A total of 1,112 CAP episodes were analyzed, with 91.4% confirmed radiologically and 43.7% confirmed microbiologically. When intra-hospital all-cause mortality was considered the primary outcome, CAP-specific scoring systems such as the Pneumonia Severity Index (PSI) and CURB-65 demonstrated superior predictive accuracy compared to more generalized scoring systems, including National Early Warning Score 2 (NEWS2), Quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS), and CRB-65. The PSI, Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) criteria, and CURB-65, alongside the Sequential Organ Failure Assessment (SOFA) score—commonly used in critical care settings—demonstrated acceptable predictive performances when compared to non-specific assessment tools. Similar trends were observed when ICU admission was used as the outcome measure. The ROC curve analysis indicated that the SOFA, PSI, IDSA/ATS, and CURB-65 scoring systems achieved area under the curve (AUC) values of 0.948, 0.879, 0.855, and 0.726, respectively, reinforcing the superior performance of CAP-specific and critical illness-related scoring systems over generic models.

These findings highlight the continued importance of accurate severity assessment in CAP management. Dedicated CAP scoring systems consistently outperformed non-specific models in predicting both mortality and ICU admission, emphasizing their value in clinical practice. The study underscores the necessity of selecting the most appropriate severity assessment tools to enhance patient outcomes, optimize resource allocation, and support evidence-based treatment decisions in CAP.

Source: bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-025-03550-y