Pneumologie 2018; 72(S 01): S96-S97
DOI: 10.1055/s-0037-1619377
Sektion 4 – Infektiologie und Tuberkulose
Posterbegehung – Titel: Pneumologische Infektiologie
Georg Thieme Verlag KG Stuttgart · New York

Sequential Organ Failure Assessment (SOFA) Score as Operationalization of Disease Severity of hospitalized Community acquired Pneumonia (CAP)

P Ahnert
1   Institut für Medizinische Informatik, Statistik und Epidemiologie, Mediziniche Fakultät, Universität Leipzig
,
P Creutz
2   Department of Infectious Disease and Respiratory Medicine, Charité Universitätsmedizin Berlin
,
F Schwarzenberger
3   Faculty of Informatics/Mathematics, Dresden University of Applied Sciences
,
M Kiehntopf
4   Integrated Biobank Jena and Institute of Clinical Chemistry and Laboratory Diagnostics, Jena University Hospital
,
M Bauer
5   Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital
,
U Völker
6   Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald
,
T Chakraborty
7   Institute for Medical Microbiology, University Hospital Gießen
,
M Löffler
1   Institut für Medizinische Informatik, Statistik und Epidemiologie, Mediziniche Fakultät, Universität Leipzig
,
N Suttorp
2   Department of Infectious Disease and Respiratory Medicine, Charité Universitätsmedizin Berlin
,
M Scholz
1   Institut für Medizinische Informatik, Statistik und Epidemiologie, Mediziniche Fakultät, Universität Leipzig
› Author Affiliations
Further Information

Publication History

Publication Date:
21 February 2018 (online)

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Purpose:

CAP (Community acquired pneumonia) is a frequent infectious disease with high mortality and a high burden on health care systems. Development of predictive biomarkers, new therapeutic concepts and epidemiologic research requires a valid, reproducible, and quantitative outcome measure describing CAP severity from uncomplicated to critical disease state. Scores evaluating severity of patients with infectious diseases were proposed in the literature. We aim to determine which serves this purpose best.

Patients and methods:

Using time series data of the first 1,532 patients enrolled in the multi-center PROGRESS study, we compared measures of CAP severity with respect to performance in correctly identifying patients with an objectively severe state of disease (death or need for intensive care with at least one of the following: substantial respiratory support, treatment with catecholamines, or dialysis). CRB-65, CURB-65, PSI, SIRS-Score, SOFA, qSOFA, Halm criteria, SCAP, SMART-COP, CRP, and PCT were compared by receiver operating characteristics using R. Patients of the PROGRESS cohort were younger than the overall population of patients hospitalized for CAP in Germany (median of 59 vs. 73 years) and showed lower in-hospital mortality (2.3% vs. 13.9%).

Results:

SOFA significantly outperformed all considered alternatives in detecting patients with a severe state of disease at the day of enrolment (AUC = 0.948), caused by higher discriminative power at higher score values. SCAP was the runner up (AUC = 0.868). SOFA performed similarly well on subsequent study days (all AUC > 0.9). In univariate and multivariate analysis, age, sex, and pack-years significantly contributed to higher SOFA values whereas antibiosis before hospitalization predicted lower SOFA.

Conclusion:

SOFA is an excellent candidate for operationalization of CAP severity, facilitating biomarker and therapeutic studies. Validation in a representative CAP population is required.