Abstract / Summary
Background: Community-acquired pneumonia (CAP) is a common serious infection, with septic shock and vasopressor requirement carrying the highest mortality. Systolic blood pressure, Multilobar infiltrates, Albumin, Respiratory rate, Tachycardia, Confusion, Oxygenation, pH (SMART-COP) was designed to predict intensive respiratory or vasopressor support, but its accuracy for isolated inotrope requirement, a surrogate for septic shock, has not been separately evaluated in Indian tertiary care settings. Aims and Objectives: The objective of this study was to compare the predictive accuracy of SMART-COP and Confusion, Urea, Respiratory rate, Blood pressure, age ≥65 years (CURB-65) for inotrope requirement in CAP patients and to assess associated outcomes. Materials and Methods: This prospective observational study included 118 adult CAP patients admitted to Bengaluru Medical College and Research Institute, Bengaluru. SMART-COP and CURB-65 scores were calculated at admission. Patients requiring inotropes (n=19) were compared with those who did not (n=99) for severity scores, SMART-COP risk category, clinical outcomes, and receiver operating characteristic performance. Results: Inotrope support was required in 16.1% of patients. Median SMART-COP score was significantly higher in the inotrope group (7.0 vs. 3.0, P<0.001). Inotrope requirement was strongly associated with mortality (63.2% vs. 11.1%, P<0.001) and mechanical ventilation (52.6% vs. 16.2%, P=0.001). Risk rose progressively with SMART-COP category: 0% low, 2.3% moderate, 25.0% high, and 66.7% very high (P<0.001). SMARTCOP showed superior predictive accuracy (area under the curve [AUC]=0.925) compared to CURB-65 (AUC=0.838). At cutoff ≥5, sensitivity was 94.7% and negative predictive value 98.7%. Conclusion: SMART-COP reliably predicts inotrope requirement and hemodynamic compromise in CAP, outperforming CURB-65, and is recommended as the preferred tool for early identification of patients at risk of septic shock to guide intensive care unit triage and timely vasopressor support.