APUA score for predicting 30-day mortality in hospitalized patients with community-acquired pneumonia

Community-acquired pneumonia (CAP) is a leading cause of emergency department (ED) visits and global mortality. Rapid and accurate risk stratification is crucial for optimizing clinical decision-making. This study aims to evaluate the APUA score's prognostic value.

This retrospective cohort study included adult patients with CAP admitted to a tertiary ED and subsequently hospitalized between June 2023 and June 2024. The study aimed to evaluate the prognostic performance of APUA score in predicting 30-day mortality. Logistic regression analysis identified independent predictors of mortality, and the prognostic performance of APUA, CURB-65, PSI, and APUA-RO₂ was assessed using receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC).

A total of 416 patients (mean age 66.6 ± 15.4 years, 62 % male) were included, with 47 (11.2 %) experiencing 30-day mortality. Multivariate analysis identified age, albumin, urea, respiratory rate (RR), and PaO₂ as independent mortality predictors. The APUA score demonstrated superior predictive ability compared to CURB-65 (AUC: 0.76 vs. 0.66) and was comparable to PSI (AUC: 0.79). The APUA-RO₂ model further improved discrimination (AUC: 0.81) and outperformed CURB-65 (p = 0.004) and APUA (p = 0.002) in mortality prediction.

The APUA score is a practical and effective tool for CAP severity assessment, offering improved predictive performance over CURB-65 while maintaining clinical usability. The APUA-RO₂ model further enhances risk stratification and may aid in ED decision-making. Further validation studies with larger patient cohorts including outpateints are needed to improve its clinical applicability.