Development and validation of a new scoring system for prognostic prediction of community-acquired pneumonia in older adults

• Published in: Scientific reports Vol. 11; no. 1; p. 23878
• Main Authors: Shirata, Masahiro, Ito, Isao, Ishida, Tadashi, Tachibana, Hiromasa, Tanabe, Naoya, Konishi, Satoshi, Oi, Issei, Hamao, Nobuyoshi, Nishioka, Kensuke, Matsumoto, Hisako, Yasutomo, Yoshiro, Kadowaki, Seizo, Ohnishi, Hisashi, Tomioka, Hiromi, Nishimura, Takashi, Hasegawa, Yoshinori, Nakagawa, Atsushi, Hirai, Toyohiro
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 13.12.2021; Nature Publishing Group UK; Nature Portfolio
• Subjects: Aged; Aged, 80 and over; Bedridden Persons - statistics & numerical data; Blood Urea Nitrogen; Community-Acquired Infections - blood; Community-Acquired Infections - epidemiology; Confidence intervals; Confusion - epidemiology; Female; Humans; Hypoxemia; Hypoxia - epidemiology; Immobilization; Male; Mortality; Mortality - trends; Multivariate analysis; Older people; Pneumonia; Pneumonia - blood; Pneumonia - epidemiology; Prediction models; Serum Albumin - metabolism; Urea
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-03440-3

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  ≤ 90% or PaO  ≤ 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.