The PROGRESS Study - Operationalization of Disease Severity and Prediction ofOutcome using the SOFA Score

CAP (Community acquired pneumonia) is frequent, with a high burden on health care systems. Optimized severity assessment and risk stratification may aid management of CAP patients and reduce mortality. Patients/methods: Using time series data of 1.532 patients of the multi-center PROGRESS study, we compared CAP severity scores for operationalization of disease severity and for their performance in correctly predicting a severe course of CAP (death or need for ICU admission: respiratory support, catecholamine therapy, dialysis). Considered scores: CRB-65, CURB-65, PSI, SIRS-Score, SOFA, qSOFA, Halm criteria, SCAP, SMART-COP, laboratory parameters CRP, PCT. Comparisons were performed by receiver operating characteristics or precision recall analysis using R. PROGRESS – patients were younger than the overall German population of hospitalized CAP patients (median of 59 vs. 73 years) with lower in-hospital mortality (2.3% vs. 13.9%). Results: SOFA significantly outperformed all considered alternatives identifying patients with severe state of disease at the day of enrolment (AUC = 0.948) and thereafter. Age, sex, pack-years significantly contributed to higher SOFA values whereas antibiosis before hospitalization predicted lower SOFA. 28-day mortality was predicted with AUCs>80%. (SOFA, PSI, SCAP, CURB-65, SMART-COP, decreasing AUC). Later ICU treatment was predicted with highest AUC below 79% (SOFA, SCAP, SMART-COP, CURB-65, Halm, PSI, decreasing AUC). Conclusion: SOFA and related scores well suited for operationalization of CAP severity. SOFA is predictive for 28-day mortality with limited specificity for the need of ICU admission