• Peter Ahnert, Petra Creutz, Katrin Horn, Fabian Schwarzenberger, Michael Kiehntopf, Hamid Hossain, Michael Bauer, Frank Martin Brunkhorst, Konrad Reinhart, Uwe Völker, Trinad Chakraborty, Martin Witzenrath, Markus Löffler, Norbert Suttorp, Markus Scholz, and PROGRESS Study Group.
• University of Leipzig, Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Härtelstr. 16-18, 04107, Leipzig, Germany. peter.ahnert@imise.uni-leipzig.de.
• Crit Care. 2019 Apr 4; 23 (1): 110110.

BackgroundCAP (Community acquired pneumonia) is frequent, with a high mortality rate and a high burden on health care systems. Development of predictive biomarkers, new therapeutic concepts, and epidemiologic research require a valid, reproducible, and quantitative measure describing CAP severity.MethodsUsing time series data of 1532 patients enrolled in the PROGRESS study, we compared putative measures of CAP severity for their utility as an operationalization. Comparison was based on ability to correctly identify 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). We considered IDSA/ATS minor criteria, CRB-65, CURB-65, Halm criteria, qSOFA, PSI, SCAP, SIRS-Score, SMART-COP, and SOFA.ResultsSOFA significantly outperformed other scores in correctly identifying a severe state of disease at the day of enrollment (AUC = 0.948), mainly caused by higher discriminative power at higher score values. Runners-up were the sum of IDSA/ATS minor criteria (AUC = 0.916) and SCAP (AUC = 0.868). SOFA performed similarly well on subsequent study days (all AUC > 0.9) and across age groups. In univariate and multivariate analysis, age, sex, and pack-years significantly contributed to higher SOFA values whereas antibiosis before hospitalization predicted lower SOFA.ConclusionsSOFA score can serve as an excellent operationalization of CAP severity and is proposed as endpoint for biomarker and therapeutic studies.Trial Registrationclinicaltrials.gov NCT02782013 , May 25, 2016, retrospectively registered.

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