Comparison of severity scoring systems A‐DROP and CURB‐65 for community‐acquired pneumonia

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Abstract
Background and objective: The initial assessment of the severity of community‐acquired pneumonia (CAP) is important for patient management. The Japanese Respiratory Society (JRS) has proposed a 6‐point scale (0–5) to assess the clinical severity of CAP. The A‐DROP scoring system assesses the following parameters: (i) Age (male ≥ 70 years, female ≥ 75 years); (ii) Dehydration (blood urea nitrogen (BUN) ≥ 210 mg/L); (iii) Respiratory failure (SaO2 ≤ 90% or PaO2 ≤ 60 mm Hg); (iv) Orientation disturbance (confusion); and (v) low blood Pressure (systolic blood pressure ≤ 90 mm Hg). A‐DROP is a modified version of CURB‐65 (confusion, BUN > 7 mmol/L (200 mg/L), respiratory rate ≥ 30/min, low blood pressure (diastolic ≤ 60 mm Hg or systolic < 90 mm Hg, and age ≥ 65 years) proposed by the British Thoracic Society. However, validation of A‐DROP has not been attempted nor has it been compared with CURB‐65. The aim of this study was to confirm that A‐DROP is equivalent to CURB‐65 for predicting severity of CAP. Methods: A retrospective observational study was conducted of patients with CAP hospitalized at a single centre between November 2005 and January 2007. The 30‐day mortality after admission was compared following assessment of severity using the A‐DROP and CURB‐65 scoring systems. Results: Three‐hundred and twenty‐nine patients were evaluated. The areas under the receiver operating characteristic curves were 0.846 (95% confidence interval (CI): 0.790–0.903) and 0.835 (95% CI: 0.763–0.908) for A‐DROP and CURB‐65, respectively. Conclusion: The JRS A‐DROP can be used to assess severity of CAP, and gives similar results to CURB‐65.