Performance and Validation of a New Long-Term Mortality Risk Score in Community-Acquired Pneumonia: A Colombian Cohort
Abstract
Background: Community-acquired pneumonia (CAP) causes significant long-term morbidity and mortality. Existing clinical scores focus on short-term outcomes, highlighting the need to validate tools that accurately predict 12-month mortality in hospitalized patients. Materials and Methods: A retrospective cohort of adults hospitalized with CAP from 2012 to 2020 was analyzed. Clinical, laboratory, radiological, and hospitalization-related data were collected. A Cox proportional hazards model was developed to predict post-acute mortality between 30 days and 12 months after hospital admission among patients with CAP who survived the first 30 days, with the cohort split 50:50. Model performance was evaluated using Area Under the Receiver Operating Characteristic Curve (AUROC) and standard diagnostic accuracy metrics. Results: A total of 13,851 patients with CAP were included. In the derivation cohort, independent predictors were altered mental status (HR 2.08; 95% CI 1.49–2.90; p < 0.05), elevated BUN (>30 mg/dL; HR 1.98; 95% CI 1.48–2.63; p < 0.05), temperature extremes (<35 °C or >39.9 °C; HR 1.98; 95% CI 1.43–2.74; p < 0.05), corticosteroid use (HR 1.85; 95% CI 1.40–2.44; p < 0.05), neoplasia (HR 1.58; 95% CI 1.08–2.32; p < 0.05), and hospital stays longer than 8 days (HR 1.39; 95% CI 1.06–1.82; p < 0.05). The new score achieved the highest AUROC (0.69; 95% CI: 0.66–0.73), followed by PSI (0.65; 95% CI: 0.62–0.69), CURB-65 (0.63; 95% CI: 0.59–0.67), and CAPSI (0.62; 95% CI: 0.58–0.67). The optimal cutoff point for the new score was 3, as determined by the Youden index (0.339). The model sensitivity was 83.0%, specificity: 50.9%, PPV: 8.9%, and NPV: 99.0%. The LR+ was 1.69 (95% CI: 1.38–2.06), and the LR− was 0.33 (95% CI: 0.27–0.41). Conclusions: The new score demonstrated weak-to-moderate discriminatory capacity. The variables included in the new score reflect multiorgan involvement, disease severity, and comorbidity burden, all of which are associated with long-term mortality.