Efficacy of Scoring Systems for Routing and Predicting Length of ICU Stay in Severe Community-Acquired Pneumonia

Scoring systems based on assessment of disease severity and patient condition are widely used for routing and predicting length of stay in the ICU. However, their effectiveness varies in patients with sepsis.

The aim of the study. To evaluate the effectiveness of scoring systems in routing and predicting ICU length of stay in patients with severe community-acquired pneumonia (CAP).

Materials and methods. Medical records of 664 patients from the Intensive Care for Severe CAP database of I. I. Mechnikov Northwestern State Medical University (2013–2023) were analyzed using the following scoring scales: CURB-65, PSI/PORT, SMART-COP, SCAP, REA-ICU, NEWS2, IDSA/ATS criteria, APACHE IV, CFS, and CCI. Statistical analysis was performed using Statistica 10.0, SPSS, and Stat Research (Center for Statistical Research) software.

Results. Among the study cohort, 96 patients (15%) had bacterial severe CAP (bCAP) and 568 patients (85%) had viral severe CAP (vCAP), all of whom were admitted to the ICU. A NEWS2 score ≥2 was observed in 74 (77.1%) bCAP patients and all vCAP patients (P<0.001). In contrast, 437 (76.9%) vCAP patients and 74 (77.1%) bCAP patients were classified as high risk according to SMART-COP (P=0.966). Delayed ICU admission (>7 days) was observed in older patients with severe bCAP, but did not significantly affect ICU length of stay or outcomes. A strong correlation was found between adverse outcome and predicted mortality using APACHE IV (η=0.966 for vCAP and η=0.807 for bCAP). However, no correlation was observed between predicted and actual ICU length of stay for both vCAP and bCAP patients (R²=0.0257, Kendall's W=0.018 for vCAP; R²=0.0294, Kendall's W=0.050 for bCAP). The predictive model accuracy for ICU stay >1 day or >14 days was not satisfactory. Model with vCAP patients adjusted for age (≥60 years) and APACHE IV exhibited moderate predictive accuracy for prolonged ICU stay (AUROC 0.610).

Conclusion. Differences were found in the applicability of the NEWS2, REA-ICU, and IDSA/ATS major criteria scoring systems for ICU routing of bCAP and vCAP patients. APACHE IV showed a strong correlation between predicted and actual mortality, but no correlation between predicted and actual ICU length of stay in severe CAP patients was found.

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