Abstract

Background and Objectives: Severe community-acquired pneumonia (SCAP) is a leading cause of sepsis, septic shock, and mortality. Various prognostic scoring systems are employed for evaluation, but their use and availability may be difficult. Our objective was to evaluate the prognostic significance of LAI, which is easy and inexpensive to perform, and the importance of its combination with PSI score in predicting mortality of SCAP patients.
Methods: This is a retrospective, single-center cross-sectional study. The patients aged ≥18 with SCAP in tertiary intensive care units were analyzed. Demographic data, PSI score, SOFA, GCS, APACHE II, laboratory parameters, and clinical variables are obtained from patient files and the hospital database. Cut-off values were used to assess the predictive accuracy of each predictor, measured by the area under the ROC curve (AUC) with a 95% confidence interval (CI). Additionally, we developed combined models for PSI+LAI utilizing various logistic regression approaches. Mortality-associated factors were examined through multivariate logistic regression analysis. Factors associated with mortality were analyzed using multivariate logistic regression analysis.
Results: The cut-off value of 110 for PSI was a good predictor with 97.8% sensitivity and 98.7% specificity. The cut-off value of 3379 for LAI was observed to be a good predictor of mortality with 92.5% sensitivity and 90.7% specificity. The AUC value for PSI was 0.987 and the AUC value for LAI was 0.933. The AUC value obtained when PSI and LAI values were evaluated together was 0.997. In multivariate analysis, high PSI score, low pulse rate, and LAI value constitute a risk for mortality.
Conclusion: Although PSI or LAI have a high predictive accuracy, their combined use may improve this accuracy and allow for more reliable management of SCAP patients. The ability of the PSI score to provide a comprehensive assessment, combined with the faster and easier application of the LAI, provides great advantages to clinicians.

Key words: Pneumonia Severity Index; Lymphocyte Albumin Index; Severe Community-Acquired Pneumonia; Mortality Prediction; Intensive Care Units