Pereira et al reported the PRoFeSs score for predicting treatment failure in severe community-acquired pneumonia. It also can identify a patient who has a poor short-term prognosis. The authors are from the University of Porto and Centra Hospitalar Sao Joao EPE in Porto, POrtugal.
Patient selection: severe community-acquired pneumonia admitted to the ICU
Parameters:
(1) Charlson comorbidity index
(2) serum lactate on day 3 in mmol/L
(3) serum procalcitonin on day 1 in ng/mL
(4) serum procalcitonin on day 3 in ng/mL
(5) D-dimer on day 3 in µg/mL
(6) serum BNP on day 1 in pg/mL
|
Parameter
|
Finding
|
Points
|
|
Charlson comorbidity
|
0 or 1
|
0
|
|
|
2 or 3
|
2
|
|
|
4 or 5
|
3
|
|
|
6 to 10
|
6
|
|
serum lactate day 3
|
<= 1.1
|
0
|
|
|
1.11 to 1.35
|
1
|
|
|
1.36 to 1.80
|
2
|
|
|
1.81 to 2.49
|
3
|
|
|
2.50 to 3.49
|
5
|
|
|
>= 3.5
|
11
|
|
serum procalcitonin day 1
|
<= 2.17
|
0
|
|
|
2.18 to 7.23
|
-1
|
|
|
7.24 to 9.42
|
-2
|
|
|
9.43 to 15.40
|
-3
|
|
|
15.41 to 27.20
|
-4
|
|
|
27.21 to 47.90
|
-7
|
|
|
47.1 to 76.10
|
-10
|
|
|
>= 76.11
|
-26
|
|
serum procalcitonin day 3
|
<= 2.93
|
0
|
|
|
2.94 to 8.64
|
1
|
|
|
8.65 to 19.40
|
2
|
|
|
19.41 to 27.40
|
4
|
|
|
27.41 to 49.20
|
6
|
|
|
>= 49.21
|
12
|
|
D-dimer day 3
|
<= 3.04
|
0
|
|
|
3.05 to 7.17
|
1
|
|
|
7.18 to 9.14
|
2
|
|
|
9.15 to 18.50
|
3
|
|
|
18.51 to 32.60
|
7
|
|
|
>= 32.61
|
10
|
|
BNP day 1
|
<= 227.0
|
0
|
|
|
227.1 to 809.0
|
-1
|
|
|
809.1 to 2140.0
|
-2
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -28 (paper says -31)
• maximum score: 39
• The higher the score the greater the risk for treatment failure.
• A cutoff of 3 had a sensitivity of 79% and specificity of 71%.
Performance:
• The area under the ROC curve is 0.81.
