Online Tool for Predicting Severe Cases of Childhood Community-Acquired Pneumonia Based on the PIRO Concept.

BACKGROUND

Pneumonia remains a leading cause of mortality among children under 5 years of age. This study aimed to compare existing prognostic scoring systems and identify the most effective tool for assessing outcomes in children with community-acquired pneumonia (CAP).

METHODS

The Predisposition, Insult, Response, and Organ Dysfunction score for CAP (PIRO-CAP) was modified to create the Ch-online PIRO score based on a comprehensive cohort study. This new scoring system was validated in a cohort of 75,965 children under the age of 5 years with CAP, treated at the Children's Hospital of Chongqing Medical University between 2016 and 2021. Effectiveness in predicting severe cases was then compared against the Pediatric Critical Illness Score (PCIS), Pneumonia Etiology Research for Child Health (PERCH) score, and PIRO-CAP score.

RESULTS

The Ch-online PIRO score retained most of the original PIRO-CAP factors, including age under 6 months, comorbidities, SpO2 below 90%, multilobar or complicated pneumonia, kidney or liver dysfunction, and respiratory failure, but replaced hypotension and bacteremia with delayed capillary refill time (> 3 s) and procalcitonin > 0.5 ng/mL. When predicting severe CAP cases, the Ch-online PIRO score demonstrated superior discriminatory performance (AUC = 0.85, 95% CI: 0.85-0.86) compared to the PCIS (AUC = 0.67, 95% CI: 0.66-0.69), PERCH score (AUC = 0.64, 95% CI: 0.64-0.65), and PIRO-CAP score (AUC = 0.68, 95% CI: 0.64-0.71).

CONCLUSION

The Ch-online PIRO score shows promise as an effective prognostic tool for assessing the severity of CAP in young children.