Predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia (SMART-COP score) in a clinical setting
SMART-COP is a simple, practical clinical tool for accurately predicting the need for intensive respiratory or vasopressor support (IRVS) that is likely to assist clinicians in determining community-acquired pneumonia (CAP) severity in a clinical setting. 
Research authors: Charles PG, Wolfe R, Whitby M, Fine MJ, Fuller AJ, Stirling R, Wright AA, Ramirez JA, Christiansen KJ, Waterer GW, Pierce RJ, Armstrong JG, Korman TM, Holmes P, Obrosky DS, Peyrani P, Johnson B, Hooy M, Grayson ML, Australian Community-Acquired Pneumonia Study Collaboration.
Details Formula Study characteristics Files & References
Model author
Model ID
Revision date
MeSH terms
  • Community Acquired Infections
  • Pneumonia
  • Severity of Illness Index
  • Vasopressor Agents
  • Respiratory Insufficiency
  • Model type
    Linear model (Calculation)
    No Formula defined yet
    Condition Formula

    Additional information

    Existing severity assessment tools, such as the pneumonia severity index (PSI) and CURB-65 (tool based on confusion, urea level, respiratory rate, blood pressure, and age <65 years), predict 30-day mortality in community-acquired pneumonia (CAP) and have limited ability to predict which patients will require intensive respiratory or vasopressor support (IRVS).

    The Australian CAP Study (ACAPS) was a prospective study of 882 episodes in which each patient had a detailed assessment of severity features, etiology, and treatment outcomes. Multivariate logistic regression was performed to identify features at initial assessment that were associated with receipt of IRVS. These results were converted into a simple points-based severity tool that was validated in 5 external databases, totaling 7464 patients.

    Patiënt population: 
    Approximately 2500 patients were assessed, and 882 episodes of CAP involving 862 patients were included. The main reasons for exclusion were normal chest radiography, receipt of parenteral antibiotics before obtainment of blood culture specimens, hospitalization within the preceding 2 weeks, or suspected aspiration. Patient demographic characteristics, clinical features (including PSI and CURB-65 scores), and sites of enrollment are shown below. 

    In ACAPS, 10.3% of patients received IRVS, and the 30-day mortality rate was 5.7%. The features statistically significantly associated with receipt of IRVS were low systolic blood pressure (2 points), multilobar chest radiography involvement (1 point), low albumin level (1 point), high respiratory rate (1 point), tachycardia (1 point), confusion (1 point), poor oxygenation (2 points), and low arterial pH (2 points): SMART-COP. A SMART-COP score of <3 points identified 92% of patients who received IRVS, including 84% of patients who did not need immediate admission to the intensive care unit. Accuracy was also high in the 5 validation databases. Sensitivities of PSI and CURB-65 for identifying the need for IRVS were 74% and 39%, respectively.

    SMART-COP is a simple, practical clinical tool for accurately predicting the need for IRVS that is likely to assist clinicians in determining CAP severity.

    Study Population

    Total population size: 882
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    Females: {{ model.numberOfFemales }}

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Age ≤50 years 213
    >50 years 669
    Gender Male 537
    Female 345
    Nursing home resident Yes 55
    No 827
    Congestive heart failure Yes 211
    No 671
    Cerebrovascular disease Yes 118
    No 764
    Malignancy Yes 42
    No 840
    Renal impariment Yes 169
    No 713
    Liver disease Yes 31
    No 851
    Smoking Yes 180
    No 702
    Asthma Yes 231
    No 651
    COPD Yes 238
    No 644
    Alcohol abuse Yes 48
    No 834
    Injection drug use Yes 17
    No 865
    Diabetes mellitus Yes 159
    No 723
    Dementia Yes 73
    No 809
    Epilepsy Yes 23
    No 859
    Neuromuscular disease Yes 25
    No 857
    Immunosuppression Yes 84
    No 798
    Antibiotic use before presentation Yes 270
    No 612
    Confusion Yes 90
    No 792
    Respiratory rate ≥30 breaths/min Yes 195
    No 687
    Tachypnea Yes 229
    No 653
    Systolic bloodpressure <90 mmHg Yes 47
    No 835
    Diastolic bloodpressure ≤60 mmHg Yes 289
    No 593
    Pulse ≥125 beats/min Yes 144
    No 738
    Pulse oximetry ≤90% Yes 231
    No 651
    Arterial pH <7.35 Yes 79
    No 432
    PaO2 <60 mmHg Yes 220
    No 291
    PaO2/FiO2 <250 Yes 197
    No 314
    Hypoxia Yes 406
    No 476
    Hematocrit <30% Yes 34
    No 848
    WBC count <4 or >15x10^9 cells/L Yes 305
    No 577
    ESR >50 Yes 266
    No 315
    Sodium level <130 mmol/L Yes 102
    No 780
    Urea level >7 mmol/L Yes 380
    No 502
    Urea level ≥11 mmol/L Yes 174
    No 708
    Glucose level ≥14 mmol/L Yes 47
    No 753
    Albumin level <3.5 g/dL Yes 455
    No 398
    CRP level >150 mg/L Yes 414
    No 439
    Multilobar CXR involvement Yes 101
    No 781
    Pleural effusion Yes 147
    No 735
    Positive result of Legionella urinary antigen test Yes 19
    No 828
    Died in the hospital Yes 41
    No 841
    Died within 30 days after admission Yes 40
    No 832
    PSI risk class Class I 109
    Class II 139
    Class III 160
    Class IV 301
    Class V 173
    CURB-65 score Class I 405
    Class II 238
    Class III 239

    Related files

    Total SMART-COP Score:

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    Total SMART-COP Score: points

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    Outcome stratification

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    Conditional information

    Result interpretation

    How this model should be used: 
    SMART-COP is a new, relatively simple, eight-variable tool that appears to identify accurately patients with community-acquired pneumonia (CAP) who will require intensive respiratory or vasopressor support (IRVS).1 The SMART-COP was developed as a useful advance for clinicians in the accurate prediction of disease severity among patients with CAP.

    Model performance:
    Several external validations of the SMART-COP have been performed so far. Overall, AUC analysis indicated good discrimination for SMART-COP scores. There was no evidence of lack of fit, indicating that the prediction probability of SMART-COP for IRVS appeared adequate. For a complete overview of available external validations, the user is referred to the validation section on Evidencio. 


    1. Charles PG, Wolfe R, Whitby M, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis. 2008;47(3):375-84

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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