Mortality Risk in Patients With Severe Sepsis and Community Acquired Pneumonia in PROWESS

Background: Patients with community-acquired pneumonia (CAP) comprised 35.6 % of the overall phase 3 Recombinant Human Activated Protein CWorldwide Evaluation in Severe Sepsis (PROWESS) study and 33.1 % of the placebo arm.We investigated the use of CURB-65, the Pneumonia Severity Index (PSI), and Acute Physiology and Chronic Health Evaluation II (APACHE II) pre-diction scores to identify the CAP population from the PROWESS placebo arm at the greatest mortality risk. Methods: Patients were classified as having CAP if the lung was the primary infection site and the patient originated from home. The abilities of CURB-65, PSI, and APACHE II scores to determine the 28-day and in-hospital mortality were compared using receiver operator characteristic (ROC) curves and the associated areas under the curve. Results: PROWESS enrolled 278 patients with CAP in the placebo arm. The areas under the ROC curves for PSI 5, CURB-65 3, and APACHE II 25 for predicting 28-day (c 0.65, 0.66, and 0.64, respectively) and in-hospital mortality (c 0.65, 0.65, and 0.64, respectively) were not statistically different from each other. The 28-day mortality of patients with a PSI score of 5, CURB-65 3, and APACHE II 25 was 41.6%, 37.9%, and 43.5%, respectively. Conclusions: Despite early diagnosis and appropriate antibiotic therapy, conventionally treated CAP with PSI 5, CURB-653, or APACHE II25 has an unacceptably high mortality. In this study, PSI, CURB-65, and APACHE II scoring systems perform similarly in predicting the 28-day and in-hospital mortality; however, differences in the categorization of severe CAP were observed and there was a significant mortality in patients with a CURB-65 <3 and PSI <5