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Objective <p>Currently, there is no effective way to identify older patients with community-acquired pneumonia (CAP) at high risk of long-term death. We aimed to develop and validate a pneumonia scoring system to predict 180-day mortality, and compare its performance with the commonly used CURB-65 score.</p> Methods <p>The prospective cohort study enrolled patients aged 65 years and older with CAP from 10 medical centers in China between April 2021 and December 2023. The primary outcome was 180-day mortality. A Cox proportional hazards model was used to develop a new pneumonia scoring system, and the area under the time-dependent curve (AUC) was used to assess its discriminatory power. Internal validation was performed using both bootstrap resampling and 10-fold cross-validation. The model was visualized by a nomogram and a questionnaire. The optimal cutoff value of the nomogram was determined based on the maximum Youden index for the 180-day mortality prediction, dividing patients into high- and low-risk groups. The performance of model in predicting both short- and long-term mortality was compared with CURB-65 using AUC, sensitivity, specificity, negative predictive value and positive predictive value.</p> Results <p>A total of 619 patients, with a median age of 78 years (IQR: 70.5–85.0), were included in the analysis. The 180-day mortality was 6.9%. The model was developed using six variables, including age, the ratio of pulse oximetry saturation (SpO<sub>2</sub>) to the fraction of inspired oxygen (FiO<sub>2</sub>), loneliness, Barthel index, Clinical Frailty Scale and malnutrition. The AUC of the model for predicting 180-day, 90-day and 30-day mortality were 0.829, 0.832 and 0.904, respectively. The cut-off value for the model was 142, while it was 2 for CURB-65. Using the cut-off values, the AUC of the model for predicting 180-day mortality was 0.768 (95% confidence interval [CI]: 0.695–0.842), significantly higher than that of CURB-65(AUC: 0.573, 95%CI: 0.488–0.659). A similar trend was observed for predictions of 90-day, 30-day and in-hospital mortality.</p> Conclusions <p>This study developed and validated a prediction model for long-term mortality in older patients with CAP, showing better discriminatory power and accuracy over CURB-65.</p>

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Development and validation of a clinical-friendly model for predicting 180-day mortality in the older with community-acquired pneumonia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月24日

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  • Bingxuan Weng,
  • Lixue Huang,
  • Wenshu Jiao,
  • Yuanqi Wang,
  • Mengyuan Wang,
  • Xuefeng Zhong,
  • Xunliang Tong,
  • Jin Jin,
  • Yanming Li

摘要

Objective

Currently, there is no effective way to identify older patients with community-acquired pneumonia (CAP) at high risk of long-term death. We aimed to develop and validate a pneumonia scoring system to predict 180-day mortality, and compare its performance with the commonly used CURB-65 score.

Methods

The prospective cohort study enrolled patients aged 65 years and older with CAP from 10 medical centers in China between April 2021 and December 2023. The primary outcome was 180-day mortality. A Cox proportional hazards model was used to develop a new pneumonia scoring system, and the area under the time-dependent curve (AUC) was used to assess its discriminatory power. Internal validation was performed using both bootstrap resampling and 10-fold cross-validation. The model was visualized by a nomogram and a questionnaire. The optimal cutoff value of the nomogram was determined based on the maximum Youden index for the 180-day mortality prediction, dividing patients into high- and low-risk groups. The performance of model in predicting both short- and long-term mortality was compared with CURB-65 using AUC, sensitivity, specificity, negative predictive value and positive predictive value.

Results

A total of 619 patients, with a median age of 78 years (IQR: 70.5–85.0), were included in the analysis. The 180-day mortality was 6.9%. The model was developed using six variables, including age, the ratio of pulse oximetry saturation (SpO2) to the fraction of inspired oxygen (FiO2), loneliness, Barthel index, Clinical Frailty Scale and malnutrition. The AUC of the model for predicting 180-day, 90-day and 30-day mortality were 0.829, 0.832 and 0.904, respectively. The cut-off value for the model was 142, while it was 2 for CURB-65. Using the cut-off values, the AUC of the model for predicting 180-day mortality was 0.768 (95% confidence interval [CI]: 0.695–0.842), significantly higher than that of CURB-65(AUC: 0.573, 95%CI: 0.488–0.659). A similar trend was observed for predictions of 90-day, 30-day and in-hospital mortality.

Conclusions

This study developed and validated a prediction model for long-term mortality in older patients with CAP, showing better discriminatory power and accuracy over CURB-65.