The Impact of Black Race on Pneumonia Severity Scoring Systems.

Background: Racial disparities disproportionately affect the morbidity and mortality of Black patients with community-acquired pneumonia (CAP). Some scoring systems used in the ICU (eg, Sequential Organ Failure Assessment, APACHE IVa) overpredict mortality in Black patients. However, to our knowledge, the performance of pneumonia severity scoring systems in White and Black adult patients has never been comprehensively evaluated. Research Question: Does Black race differentially impact the ability of pneumonia severity scoring systems to predict in-hospital mortality, direct ICU admission, or identify severe CAP? Study Design and Methods: This was a secondary analysis of 2 prospective cohorts of patients with SARS-CoV-2 CAP and non-SARS-CoV-2 CAP from 8 adult hospitals in Louisville, Kentucky. The following pneumonia severity scores were assessed: Pneumonia Severity Index; CURB-65; Confusion, Oxygenation, Respiratory Rate, and Blood Pressure scale; American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) 2007 criteria; SMART-COP; Severe Community-Acquired Pneumonia (SCAP) score; and Risk of Early Admission to ICU Index. Results: For Black and White patients with CAP, the in-hospital mortality rate was 5.6% vs 7.5% ( Interpretation: Our results show that most pneumonia severity scores perform equally well for predicting in-hospital mortality and direct ICU admission in White and Black patients except the ATS/IDSA 2007 criteria, which showed superior performance in Black patients when predicting in-hospital mortality. Before implementation in clinical practice, it is important to consider the limitations of pneumonia severity scores and their subsequent impact on equitable care delivery.