Development and validation of a new scoring system for prognostic prediction of community-acquired pneumonia in older adults
Masahiro Shirata, Isao Ito, Tadashi Ishida, Hiromasa Tachibana, Naoya Tanabe, Satoshi Konishi, Issei Oi, Nobuyoshi Hamao, Kensuke Nishioka, Hisako Matsumoto, Yoshiro Yasutomo, Seizo Kadowaki, Hisashi Ohnishi, Hiromi Tomioka, Takashi Nishimura, Yoshinori Hasegawa, Atsushi Nakagawa, Toyohiro Hirai
Abstract
Abstract The discriminative power of CURB-65 for mortality in community-acquired pneumonia (CAP) is suspected to decrease with age. However, a useful prognostic prediction model for older patients with CAP has not been established. This study aimed to develop and validate a new scoring system for predicting mortality in older patients with CAP. We recruited two prospective cohorts including patients aged ≥ 65 years and hospitalized with CAP. In the derivation (n = 872) and validation cohorts (n = 1,158), the average age was 82.0 and 80.6 years and the 30-day mortality rate was 7.6% (n = 66) and 7.4% (n = 86), respectively. A new scoring system was developed based on factors associated with 30-day mortality, identified by multivariate analysis in the derivation cohort. This scoring system named CHUBA comprised five variables: confusion, hypoxemia (SpO 2 ≤ 90% or PaO 2 ≤ 60 mmHg), blood urea nitrogen ≥ 30 mg/dL, bedridden state, and serum albumin level ≤ 3.0 g/dL. With regard to 30-day mortality, the area under the receiver operating characteristic curve for CURB-65 and CHUBA was 0.672 (95% confidence interval, 0.607–0.732) and 0.809 (95% confidence interval, 0.751–0.856; P < 0.001), respectively. The effectiveness of CHUBA was statistically confirmed in the external validation cohort. In conclusion, a simpler novel scoring system, CHUBA, was established for predicting mortality in older patients with CAP.