The predictive validity for mortality in community-acquired pneumonia of qSOFA was greater than IDSA/ATS minor criteria

Abstract

<b>Background:</b> The contribution of and the validities of cut-offs for individual quick Sequential Organ Failure Assessment (qSOFA) elements, and the discriminatory capacity of qSOFA vs IDSA/ATS minor criteria for predicting mortality in patients with community-acquired pneumonia (CAP) remain unknown. <b>Methods:</b> A prospective cohort study of 2116 CAP patients was performed. The primary outcome was in-hospital mortality. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC) and net reclassification improvement (NRI). <b>Results:</b> Overall mortality was 6.43%: 3.05% for patients with qSOFA &lt;2 vs 25.96% for those with qSOFA ≥2. The predictive validities of respiratory rate ≥22 breaths/min, altered mentation, and systolic blood pressure ≤100 mm Hg were good, adequate, and poor for mortality (AUROC, 0.833, 0.717, 0.668), respectively. Respiratory rate ≥22 breaths/min best predicted mortality among the three cut-offs (&gt;20 breaths/min and ≥30 breaths/min). The discrimination of mortality using systolic arterial pressure ≤100 mm Hg was greater compared with hypotension. qSOFA had a sensitivity of 59.6%, specificity of 88.3%, and positive likelihood ratio of 5.105 for predicting mortality. The predictive validity of qSOFA was good for mortality (AUROC = 0.868), was statistically greater than minor criteria, was equal to PSI, and was inferior compared with CURB-65 (AUROC, 0.824, 0.902, 0.919; NRI, 0.088, -0.068, -0.103; respectively). <b>Conclusions:</b> The parsimonious qSOFA as a bedside prompt might be positioned as a proxy for IDSA/ATS minor criteria.