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Role of Expanded A-DROP Score in Predicting 14-day Mortality in Patients with Community-acquired Pneumonia: A
Reshma Prakash1, Nitin Sinha2, Parul Goyal3
13rd Year Postgraduate Resident, Department of General Medicine, Dr Ram Manohar Lohia Hospital, Delhi, India, Corresponding Author.
Background:
Community-acquired pneumonia (CAP) carries substantial mortality. Common scoring tools such as CURB-65, A-DROP, and PSI have limitations. The expanded A-DROP incorporates clinical and biochemical markers, showing promise and requires validation in Indian settings.
Materials And Methods:
This prospective observational study at a North Indian tertiary center (March 2024-June 2025) included 80 adults with CAP. Expanded A-DROP scores were calculated within 24 hours of admission, and patients were followed for ICU admission, in-hospital, and 14-day postdischarge mortality. Analyses used ANOVA, Chi-square, logistic regression, and receiver operating characteristic (ROC) curves (p < 0.05).
Results:
Of 80 patients, 22 (27.5%) died within 14 days. Mortality was 1/23 (4.3%) in group I (0-2), 2/22 (9.1%) in group II (3-4), and 19/35 (54.3%) in group III (≥5) (p < 0.001). ICU admission rose with severity: 1/23 (4.3%), 8/22 (36.4%), and 25/35 (71.4%) (p < 0.001). Mean (SD) hospital stay increased: 4.0 (0.9), 7.0 (1.1), and 9.0 (1.3) days (p < 0.0001), with positive correlation to score (ρ = 0.53, p < 0.000001). ROC analysis gave an AUC of 0.871 (95% CI: 0.783-0.958). A score ≥5 predicted mortality with 86.2% sensitivity and 72.4% specificity. Multivariate regression identified Expanded A-DROP as the only independent predictor (OR 3.07, p < 0.001).
Conclusion:
Expanded A-DROP demonstrated strong predictive power for short-term mortality, ICU requirement, and hospital stay in CAP. It is a simple, clinically relevant, and effective tool for early triage, especially in resource-limited settings.
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