Updating cut-off values of severity scoring systems for community-acquired pneumonia to orchestrate more predictive accuracy
AbstractBackground: The assessment of severity is crucial in the management of community-acquired pneumonia (CAP). It remains unknown whether updating cut-off values of severity scoring systems orchestrate improvement in predictive accuracy.Methods: 3,212 patients with CAP were recruited to two obse...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2023-12-01
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| Series: | Annals of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/07853890.2023.2202414 |
| _version_ | 1797353733987762176 |
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| author | Qi Guo Hai-yan Li Wei-dong Song Ming Li Xiao-ke Chen Hui Liu Hong-lin Peng Hai-qiong Yu Nian Liu Yan-hong Li Zhong-dong Lü Li-hua Liang Qing-zhou Zhao Mei Jiang |
| author_facet | Qi Guo Hai-yan Li Wei-dong Song Ming Li Xiao-ke Chen Hui Liu Hong-lin Peng Hai-qiong Yu Nian Liu Yan-hong Li Zhong-dong Lü Li-hua Liang Qing-zhou Zhao Mei Jiang |
| author_sort | Qi Guo |
| collection | DOAJ |
| description | AbstractBackground: The assessment of severity is crucial in the management of community-acquired pneumonia (CAP). It remains unknown whether updating cut-off values of severity scoring systems orchestrate improvement in predictive accuracy.Methods: 3,212 patients with CAP were recruited to two observational prospective cohort studies. Three bettered scoring systems were derived from the corresponding well-established and extensively used pneumonia-specific severity scoring systems, i.e. pneumonia severity index, minor criteria and CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30/min, low blood pressure, and age ≥65 years) score, with the updating cut-off values for tachypnea and low blood pressure. Cronbach α was employed to determine construct validity. Discrimination was valued by calculating the area under the receiver operating characteristic curve (AUROC) and net reclassification improvement (NRI).Results: Respiratory rate ≥22/min and systolic blood pressure ≤100 mm Hg were performed better than respiratory rate ≥30/min and hypotension for predicting mortality in the derivation cohort, respectively (AUROC, 0.823 vs 0.519, 0.688 vs 0.622; NRI, 0.61, 0.13). Bettered scoring systems orchestrated higher convergences, indicated by greater Cronbach α and more decrease in Cronbach α if the updating cut-off values were deleted. The six scoring systems agreed well with one another. Bettered- pneumonia severity index, minor criteria and CURB-65 score showed higher associations with severity and mortality rates and demonstrated greater predictive accuracies for mortality compared with the corresponding original systems (AUROC, 0.939 vs 0.883, 0.909 vs 0.871, 0.913 vs 0.859; NRI, 0.113, 0.076, 0.108; respectively). The validation cohort confirmed a similar pattern.Conclusions: Updating cut-off values of severity scoring systems for CAP orchestrate improvement in predictive accuracy, suggesting that it may facilitate the rationalization of clinical triage decision-making and further reduce mortality. The current studies provide the first known prospective evidence of potential benefit of the updating cut-off values of severity scoring systems for CAP in predictive accuracy.Key messagesUpdating cut-off values were performed better for predicting mortality.Bettered scoring systems orchestrated higher convergences.Bettered scoring systems demonstrated greater predictive accuracies for mortality. |
| first_indexed | 2024-03-08T13:35:20Z |
| format | Article |
| id | doaj.art-5f230c72692e4de39d4c41ba354d82ab |
| institution | Directory Open Access Journal |
| issn | 0785-3890 1365-2060 |
| language | English |
| last_indexed | 2024-03-08T13:35:20Z |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Annals of Medicine |
| spelling | doaj.art-5f230c72692e4de39d4c41ba354d82ab2024-01-16T19:13:22ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602023-12-0155110.1080/07853890.2023.2202414Updating cut-off values of severity scoring systems for community-acquired pneumonia to orchestrate more predictive accuracyQi Guo0Hai-yan Li1Wei-dong Song2Ming Li3Xiao-ke Chen4Hui Liu5Hong-lin Peng6Hai-qiong Yu7Nian Liu8Yan-hong Li9Zhong-dong Lü10Li-hua Liang11Qing-zhou Zhao12Mei Jiang13Department of Pulmonary and Critical Care Medicine, Shenzhen Hospital, Peking University, Shenzhen, Guangdong, P.R. ChinaDepartment of General Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, P.R. ChinaDepartment of Pulmonary and Critical Care Medicine, Shenzhen Hospital, Peking University, Shenzhen, Guangdong, P.R. ChinaDepartment of Pulmonary and Critical Care Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, P.R. ChinaDepartment of Pulmonary and Critical Care Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, P.R. ChinaDepartment of Pulmonary and Critical Care Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, P.R. ChinaDepartment of Pulmonary and Critical Care Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, P.R. ChinaDepartment of Pulmonary and Critical Care Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, P.R. ChinaDepartment of Pulmonary and Critical Care Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, P.R. ChinaDepartment of Pulmonary and Critical Care Medicine, Shenzhen Hospital, Peking University, Shenzhen, Guangdong, P.R. ChinaDepartment of Pulmonary and Critical Care Medicine, Shenzhen Hospital, Peking University, Shenzhen, Guangdong, P.R. ChinaDepartment of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, P.R. ChinaDepartment of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, P.R. ChinaState Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, P.R. ChinaAbstractBackground: The assessment of severity is crucial in the management of community-acquired pneumonia (CAP). It remains unknown whether updating cut-off values of severity scoring systems orchestrate improvement in predictive accuracy.Methods: 3,212 patients with CAP were recruited to two observational prospective cohort studies. Three bettered scoring systems were derived from the corresponding well-established and extensively used pneumonia-specific severity scoring systems, i.e. pneumonia severity index, minor criteria and CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30/min, low blood pressure, and age ≥65 years) score, with the updating cut-off values for tachypnea and low blood pressure. Cronbach α was employed to determine construct validity. Discrimination was valued by calculating the area under the receiver operating characteristic curve (AUROC) and net reclassification improvement (NRI).Results: Respiratory rate ≥22/min and systolic blood pressure ≤100 mm Hg were performed better than respiratory rate ≥30/min and hypotension for predicting mortality in the derivation cohort, respectively (AUROC, 0.823 vs 0.519, 0.688 vs 0.622; NRI, 0.61, 0.13). Bettered scoring systems orchestrated higher convergences, indicated by greater Cronbach α and more decrease in Cronbach α if the updating cut-off values were deleted. The six scoring systems agreed well with one another. Bettered- pneumonia severity index, minor criteria and CURB-65 score showed higher associations with severity and mortality rates and demonstrated greater predictive accuracies for mortality compared with the corresponding original systems (AUROC, 0.939 vs 0.883, 0.909 vs 0.871, 0.913 vs 0.859; NRI, 0.113, 0.076, 0.108; respectively). The validation cohort confirmed a similar pattern.Conclusions: Updating cut-off values of severity scoring systems for CAP orchestrate improvement in predictive accuracy, suggesting that it may facilitate the rationalization of clinical triage decision-making and further reduce mortality. The current studies provide the first known prospective evidence of potential benefit of the updating cut-off values of severity scoring systems for CAP in predictive accuracy.Key messagesUpdating cut-off values were performed better for predicting mortality.Bettered scoring systems orchestrated higher convergences.Bettered scoring systems demonstrated greater predictive accuracies for mortality.https://www.tandfonline.com/doi/10.1080/07853890.2023.2202414Community-acquired pneumoniaSeverity scoring systemCut-off value updatedMortality |
| spellingShingle | Qi Guo Hai-yan Li Wei-dong Song Ming Li Xiao-ke Chen Hui Liu Hong-lin Peng Hai-qiong Yu Nian Liu Yan-hong Li Zhong-dong Lü Li-hua Liang Qing-zhou Zhao Mei Jiang Updating cut-off values of severity scoring systems for community-acquired pneumonia to orchestrate more predictive accuracy Annals of Medicine Community-acquired pneumonia Severity scoring system Cut-off value updated Mortality |
| title | Updating cut-off values of severity scoring systems for community-acquired pneumonia to orchestrate more predictive accuracy |
| title_full | Updating cut-off values of severity scoring systems for community-acquired pneumonia to orchestrate more predictive accuracy |
| title_fullStr | Updating cut-off values of severity scoring systems for community-acquired pneumonia to orchestrate more predictive accuracy |
| title_full_unstemmed | Updating cut-off values of severity scoring systems for community-acquired pneumonia to orchestrate more predictive accuracy |
| title_short | Updating cut-off values of severity scoring systems for community-acquired pneumonia to orchestrate more predictive accuracy |
| title_sort | updating cut off values of severity scoring systems for community acquired pneumonia to orchestrate more predictive accuracy |
| topic | Community-acquired pneumonia Severity scoring system Cut-off value updated Mortality |
| url | https://www.tandfonline.com/doi/10.1080/07853890.2023.2202414 |
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