ORIGINAL RESEARCH
Intensive Care
doi: 10.25005/2074-0581-2025-27-4-841-855
COMPARISON OF THE EFFECTIVENESS OF FORMALIZED SCORING SYSTEMS IN PREDICTING OUTCOMES IN PATIENTS WITH SEVERE COMMUNITY-ACQUIRED PNEUMONIA OF BACTERIAL AND VIRAL ETIOLOGY

I.A. RUSLYAKOVA, E.Z. SHAMSUTDINOVA, YU.A. MIRONOVA, I.S. CHERTSOV, K.I. SHIROKOV, E.B. AVALUEVA

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation

Objective: To compare outcome prediction scales and stratify risk groups high short-term mortality of patients with sCAP of viral and bacterial etiology.

Methods: We conducted a pro- and retrospective analysis of 664 medical records of patients treated between 2013 and 2023. Prospective outcome prediction was performed using the following scores and indices: SOFA, APACHE II, CCI, CFS, PSI/PORT, SMART-COP, CURB-65, REA-ICU, SCAP, IDSA/ATS major/minor criteria, APACHE IV, SAPS II, and mNUTRIC. Retrospectively, patients were assessed using the MuLBSTA score. Predictive accuracy of the scales was evaluated with ROC analysis. Statistical analysis was performed using the Jamovi software package.

Results: Data from 664 patients met inclusion criteria: 96 (14.5%) with bacterial sCAP (b-sCAP) and 568 (85.5%) with viral sCAP (v-sCAP). In v-sCAP, excellent predictive accuracy was demonstrated by APACHE II, APACHE IV, REA-ICU (AUC-ROC 0.97; 0.96; 0.97), and the IDSA/ATS criteria (AUC-ROC 0.96). In b-sCAP, good informativeness was shown by mNUTRIC and APACHE II (AUC-ROC 0.78; 0.73) and by the IDSA/ATS criteria (AUC-ROC 0.77). Within-group comparisons revealed increased risk of in-hospital mortality in high-risk v-sCAP patients across all scales used, and a shorter ICU length of stay ≤3 days when REA-ICU was ≥7 points and when IDSA/ATS major ≥1 and minor ≥3 criteria were observed. In b-sCAP, analogous group comparisons did not show differences in ICU length of stay; however, a higher risk of unfavorable outcome was recorded for REA-ICU ≥7, SCAP ≥10, and IDSA/ATS major ≥1 plus minor ≥3 criteria.

Conclusion: The IDSA/ATS criteria demonstrated sufficient discriminative ability for outcome prediction and similar threshold values for stratifying the risk of short-term mortality in patients with severe sCAP of both viral and bacterial etiology

Keywords: Community-acquired pneumonia, scoring systems, prognosis, mortality, intensive care unit, outcomes.

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Authors' information:

Ruslyakova Irina Anatolyevna,
Candidate of Medical Sciences, Assistant Professor of the Department of Anesthesiology and Intensive Care named after V.L. Vanevsky, Head of the Department of Intensive Care for medical patients, North-Western State Medical University named after I.I. Mechnikov
Scopus ID: 57221223010
ORCID ID: 0000-0003-1507-833X
SPIN: 3417-8804
E-mail: ruslyakova777dok@gmail.com

Shamsutdinova Elvina Zinurovna,
Intensivist of the Department of Intensive Care for medical patients, North-Western State Medical University named after I.I. Mechnikov
ORCID ID: 0009-0003-5800-8697
SPIN: 9416-7728
E-mail: Elvina.Shamsutdinova@szgmu.ru

Mironova Yulia Aleksandrovna,
Clinical Resident of the Department of Anesthesiology and Intensive Care named after V.L. Vanevsky, North-Western State Medical University named after I.I. Mechnikov
ORCID ID: 0009-006-7256-6419
E-mail: juliatomashevich27@gmail.com

Chertsov Ilya Sergeevich,
Clinical Resident of the Department of Anesthesiology and Intensive Care named after V.L. Vanevsky, North-Western State Medical University named after I.I. Mechnikov
ORCID ID: 0009-0005-7864-8012
E-mail: ilja.tchertzoff@yandex.ru

Shirokov Kirill Igorevich,
Graduate Student of the North-Western State Medical University named after I.I. Mechnikov
ORCID ID: 0009-0008-4787-596X
E-mail: kirillkem03@gmail.ru

Avalueva Elena Borisovna, Doctor of Medical Sciences, Professor of the Department of Propaedeutics of Internal Diseases, Gastroenterology and Dietetics named after S.M. Ryss, North-Western State Medical University named after I.I. Mechnikov
Researcher ID: L-2666-2014
Scopus ID: 8902888000
ORCID ID: 0000-0001-6011-0998
E-mail: avalueva@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Ruslyakova Irina Anatolyevna
Candidate of Medical Sciences, Assistant Professor of the Department of Anesthesiology and Intensive Care named after V.L. Vanevsky, Head of the Department of Intensive Care for medical patients, North-Western State Medical University named after I.I. Mechnikov

195067, Russian Federation, Saint-Petersburg, Piskaryovskiy Ave., 47

Tel.: +7 (921) 9183259

E-mail: Irina.Ruslyakova@szgmu.ru


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