PRoFeSs score reliably predicts poor outcomes in severe community-acquired pneumonia
The PRoFeSs score―which includes the Charlson score, as well as levels of day 3 lactate, day 1 and day 3 procalcitonin, day 3 D-dimer, and day 1 brain-type natriuretic peptide (BNP)―can identify severe community-acquired pneumonia (SCAP) patients at high risk of poor outcomes 5 days after ICU admission, a recent study has found.
Researchers conducted a single-centre, prospective cohort study including 107 ICU patients (mean age, 62.0±15.7 years; 60.7 percent male) diagnosed with SCAP. The study’s primary outcome included death and the lack of ≥2-point improvements in scores in the Sequential Organ Failure Assessment within 5 days of treatment.
Six variables emerged as significantly predictive of the primary outcome. For instance, Charlson score (adjusted odds ratio [OR], 1.330, 95 percent CI, 1.059–1.669; p=0.021) and day 3 concentrations of D-dimer (adjusted OR, 2.185, 1.352–3.530; p=0.001) were strongly and positively correlated with the likelihood of the primary outcome.
The same was true for day 3 concentrations of procalcitonin (adjusted OR, 1.635, 0.993–4.692; p=0.016) and lactate (adjusted OR, 1.954, 1.093–3.498; p=0.03).
In comparison, day 1 levels of BNP (adjusted OR, 0.950, 0.901–1.001; p=0.047) and procalcitonin (adjusted OR, 0.572, 0.355–0.922; p=0.003) were significantly but inversely correlated with the primary outcome.
Consolidating all factors into one predictive model produced the PRoFeSs score, which had an area under the receiver operating characteristic curve of 0.81 (0.72–0.89). At a cutoff of 3 points, sensitivity and specificity are both maximized, yielding values of 79 percent and 71 percent, respectively.