Comparison of three prediction rules for prognosis in community acquired pneumonia: Pneumonia Severity Index (PSI), CURB-65, and A-DROP]

Several severity scores have been proposed to predict patient outcome and guide initial management of patients with community acquired pneumonia (CAP). The Japan Respiratory Society (JRS) has proposed new predicting scores, A-DROP system (score 0-5, Age : male 70 years and more, female 75 years and more, BUN > 21 mg/dl, SpO2 < 90% or PaO2 < 60 Torr, confusion, systolic blood pressure < 90 mmHg). We aimed to compare the predictive value of these instruments regarding 30-day mortality.All patients with an admission diagnosis of CAP from April 2002-March 2006 were reviewed. Clinical and laboratory features at presentation on electrical medical records were used to calculate severity scores using the Pneumonia Severity Index (PSI), CURB-65 (2004) and A-DROP (2005). Patients were categorized into PSI risk classes (I-V) and CURB-65 (0-5) and A-DROP (0-5) risk strata.Consecutive 523 patients (61% male) of mean age 70.5 years were included in the analysis. Thirty-one (5.9%) patients died and 12 (2.2%) patients required ventilatory support. ROC analysis for predicting mortality at 30 days showed that A-DROP score has similar power for short-term mortality to PSI, and slightly more accurate in identifying patients at low risk than the CURB-65 score.