Prognostic values of scoring systems in patients diagnosed with community-acquired pneumonia in the emergency department

Objective: It is very important to predict the severity of the disease course in a patient with pneumonia in a limited time in busy and crowded emergency services. In our study, we aimed to determine the easiest and most effective scoring system that can be used in the emergency department in clinical practice in determining the short-term mortality and prognosis of patients with pneumonia, using the pneumonia severity scoring system. Materials and Methods: Our study was conducted prospectively between September 2020 and January 2022 in Çukurova University Faculty of Medicine, Department of Emergency Medicine, after the approval of Çukurova University Non-Interventional Clinical Research Ethics Committee at the meeting numbered 103 on September 4, 2020. Patients over the age of 18 who were diagnosed with pneumonia in the emergency department with clinical, physical examination, radiological and laboratory features and gave their consent for the study were included in the study. The data of 90 patients included in the study were obtained at the time of admission to the emergency department, and their hospitalization and outcomes were followed. Demographic data of patients, vital signs, history, comorbidities, type and severity of pneumonia diagnosed in the patient, laboratory values, microbiological factor analyses, direct X-ray and computed tomography imaging findings, CURB – 65, Expanded CURB – 65, SCAP, PSI, SMART COP, SOFA, qSOFA, A – DROP scores, hospitalization unit, patient outcome, short-term mortality data (exitus status in the first 15/30 days) were recorded. Results: Of the 90 patients included in our study, 42.2% (n=38) were female and 57.8% (n=52) were male, with a mean age of 67.19±14.96 years. Our thesis study coincided with the pandemic period when there was no effective vaccination, and although 75 of our patients were PCR positive and the other 15 patients were PCR negative, COVID-19 cannot be excluded. Considering the anatomical location of the pneumonia area of the patients, it was observed that 83 (92.2%) had interstitial pneumonia and 7 had lobar bronchopneumonia. When the clinical picture was examined, atypical pneumonia was observed in 84 (93.3%) patients, and typical pneumonia was observed in 6 patients, while severe pneumonia was found in 67 (74.4%) patients and mild pneumonia in 23 patients according to the pneumonia severity. When the hospitalization data of the patients were evaluated, it was seen that 46 (51.1%) were hospitalized in the ward and 44 in the intensive care unit. The mean number of hospitalization days of the patients was found to be 12.23±8.05. 14 (15.6%) of the patients were intubated in the first 24 hours, and 12 (85.7%) of these patients were COVID-19 PCR positive. All of the patients who were intubated in the first 24 hours were found to be exitus in the first 30 days. When the mortality data of all patients were examined, it was seen that 44 (48.9%) of the patients included in our study were dead. When the short-term mortality data of the patients were examined, it was seen that 34 (37.7%) were hospitalized within the first 15 days, 41 (45.5%) were hospitalized within the first 30 days, and 3 (3.3%) were hospitalized after the first 30 days. It was found that there was an exitus inside. It was observed that 46 (51.1%) of the patients were discharged with cure. When the scoring scores of the patients hospitalized in the service and intensive care unit are statistically analyzed, all the scoring systems we calculated (CURB-65, Expanded CURB-65, PSI, SCAP, SMART-COP, SOFA, qSOFA, A-DROP) scores were significant in terms of determining admission to the ward. According to the ROC analyzes of the patients, the scoring with the highest sensitivity in 15-day mortality was found to be qSOFA, while the scoring with the highest specificity was found to be SOFA and A-DROP. When the ROC analyzes of the patients for 30-day mortality were evaluated, it was found that the scoring with the highest sensitivity was again qSOFA, while the scoring with the highest specificity was CURB-65 Expanded with SOFA. Conclusion: In our study, it was observed that a qSOFA score of 1 and above predicted mortality in the first 15 and first 30 days with high sensitivity in pneumonia patients admitted to the emergency department. Therefore, the qSOFA score, which is independent of laboratory parameters and calculated with vital signs, was thought to be quite effective in predicting mortality without waiting for the blood results of the patients in the emergency department and in deciding for intensive care admission. For the first 15 days of mortality, the A-DROP score was equally high with the SOFA score, and it was concluded that the A-DROP score was easier to calculate and could be used more effectively in crowded emergency rooms. In addition, 'need for intubation in the first 24 hours' in patients with COVID-19 pneumonia can be considered as a poor prognostic factor for mortality. Keywords: Pneumonia, Viral Pneumonia, COVID-19, Mortality, Prognosis