Modified IDSA/ATS Minor Criteria for Severe Community-Acquired Pneumonia Best Predicted Mortality

Abstract

It is not clear whether the IDSA/ATS minor criteria for severe community-acquired pneumonia (CAP) could be simplified or even be modified to orchestrate improvements in predicting mortality.A retrospective cohort study of 1230 CAP patients was performed to simplify and to modify the scoring system by excluding 4 noncontributory or infrequent variables (leukopenia, hypothermia, hypotension, and thrombocytopenia) and by excluding these variables and then adding age ≥65 years, respectively. The simplification and modification were tested against a prospective 2-center validation cohort of 1409 adults with CAP.The increasing numbers of IDSA/ATS, simplified, and modified minor criteria present in the retrospective cohort were positively associated with the mortality, showing significant increased odds ratios for mortality of 2.711, 4.095, and 3.755, respectively. The validation cohort confirmed a similar pattern. The sensitivity, specificity, positive predictive value, and Youden index of modified minor criteria for mortality prediction were the best pattern in the retrospective cohort. High values of corresponding indices were confirmed in the validation cohort. The highest accuracy of the modified version for predicting mortality in the retrospective cohort was illustrated by the highest area under the receiver operating characteristic curve of 0.925 (descending order: modified, simplified, and IDSA/ATS minor criteria). The validation cohort confirmed a similar paradigm.The IDSA/ATS minor criteria could be simplified to 5 variables and then be modified to orchestrate improvements in predicting mortality in CAP patients. The modified version best predicted mortality. These were more suitable for clinic and emergency department.

Risk factors associated with mortality in hospitalized patients with SARS-CoV-2 infection. A prospective, longitudinal, unicenter study in Reus, Spain

“…We excluded hospitalized patients with suspected SARS-CoV-2 infection but without laboratory confirmation, or patients who did not require hospitalization, with or without laboratory diagnosis of SARS-CoV-2 infection. Thirty-four patients required transfer to the Intensive Care Unit based on the attending specialist’s criteria, and taking into account the CURB65 scale and the ATS/IDSA criteria [16,17]. This study was approved by the Ethics Committee of our Institution (Resolution CEIM 040/2018, amended on 16 April 2020).…”

Utility of community‐acquired pneumonia severity scores in guiding disposition from the emergency department: Intensive care or short‐stay unit?

“…For the IDSA/ATS guideline, only the minor criteria were assessed (threshold ≥3), as the major criteria (mechanical ventilation and vasopressor support) would normally present a clear indication for ICU admission. This approach has been adopted previously . Diagnostic accuracy of the lowest severity class for each score was then assessed for prediction of discharge within 48 h. These thresholds were PSI class I, CURXO score ≤4 (no major or minor criteria), no major or minor IDSA/ATS criteria and a score of zero points for CURB‐65, CORB and SMARTCOP.…”

Issues in Community-Acquired Pneumonia

“…A validation study of 1062 patients with CAP, not meeting the major criteria, found the minor criteria were equivalent to the SMART-COP scoring system for predicting need for mechanical ventilation, vasopressor support, and ICU care [59]. Recently, other investigators have modified the IDSA/ATS minor criteria by excluding four infrequent variables [leucopenia, hypothermia, hypotension, and thrombocytopenia] but adding age ≥65 years [60]. The modified version best-predicted mortality, but it is unclear whether it is as useful for predicting need for ICU care and vasopressor/ventilation support.…”