Predictive Value of SMART-COP for Adverse Outcomes in Older ICU Patients with Community-Acquired Pneumonia: A Comparison with CURB-65, SOFA, and APACHE II

Background/Objectives: Community-acquired pneumonia (CAP) is a leading cause of ICU admission and death in older adults, yet the severity scores used in this setting were not developed for, or validated in, older intensive care patients. We compared a pneumonia-specific score (SMART-COP) with the general ICU scores SOFA and APACHE II and with CURB-65 for predicting adverse outcomes in this population. Methods: In this single-center prospective observational study, 227 consecutive patients aged ≥65 years admitted to the ICU with CAP were enrolled. SMART-COP and CURB-65 were calculated at hospital admission and SOFA and APACHE II at ICU admission. The discrimination of each score for four outcomes—in-ICU mortality, need for intubation, vasopressor requirement, and hospital-acquired pneumonia (HAP)—was assessed by ROC analysis, and areas under the curve (AUCs) were compared pairwise using the DeLong test. Results: All four scores predicted mortality, intubation, and vasopressor requirement (all p ≤ 0.001), but none discriminated well for HAP (all AUCs < 0.70). SMART-COP had the highest AUCs for mortality (0.846) and intubation (0.870), significantly exceeding CURB-65 (both p < 0.01) while performing comparably to SOFA and APACHE II. SOFA was the strongest predictor of vasopressor requirement (AUC: 0.867). Conclusions: In older ICU patients with CAP, SMART-COP—calculable from routine parameters at admission—matched far more complex ICU scores for mortality and intubation and outperformed CURB-65. The optimal score depends on the outcome of interest.