External validation in 608 patients from the LOS cohort (1998-1999)
Description of validation cohort:
This external validation was performed on the Length of Stay project (LOS) cohort consisting of 608 patients with community-acquired pneumonia. 

Location:
Pittsburgh, PA.

Dates:
February 1998 to March 1999.

Inclusion criteria:
Age ≥18 years, CAP diagnosis, chest X-ray changes. 

Exclusion criteria:
Admitted withing preceding 10 days, HIV infected, cystic fibrosis, active tuberculosis, immunosuppression (i.e., HIV infection, WBC count ! 3000 cells/mm3 , asplenia, hypogammaglobulinemia, use of myelosuppressive medications, corticosteroid use, or organ transplantation), injection drug use, alcohol abuse, or receipt of only palliative care.

Model performance: 
The AUC in this external validation cohort was 0.82 (95% CI: 0.77-0.86). Corresponding sensitivity and specificity rates were 69% and 73%. The corresponding Hosmer-Lemeshow goodness-of-fit P value was 0.07. 
Validation study 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
Validation author
Revision date
2017-11-28
MeSH terms
  • Community Acquired Infections
  • Pneumonia
  • Severity of Illness Index
  • Vasopressor Agents
  • Respiratory Insufficiency
  • Validation Studies
  • Status
    public
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    Details

    Discrimination

    Rows included 0
    C-index 0.82
    Brier score Not specified
    Scaled Brier score Not specified
    ROC Plot:
    Not specified

    Calibration

    Regression coefficient Not specified
    Intercept Not specified
    Hosmer-Lemeshow GOF < 0.001
     
    Calibration plot:
    Not specified

    Histogram

    Not specified

    Decision curve

    Not specified
    Comparison
    Original study population: 882
    Validation study population: 608

    Categorical characteristics

    Name Subset / Group Nr. of patients Validation P-Value
    Age ≤50 years 213 Not available
    >50 years 669
    Gender Male 537 Not available
    Female 345
    Nursing home resident Yes 55 Not available
    No 827
    Congestive heart failure Yes 211 Not available
    No 671
    Cerebrovascular disease Yes 118 Not available
    No 764
    Malignancy Yes 42 Not available
    No 840
    Renal impariment Yes 169 Not available
    No 713
    Liver disease Yes 31 Not available
    No 851
    Smoking Yes 180 Not available
    No 702
    Asthma Yes 231 Not available
    No 651
    COPD Yes 238 Not available
    No 644
    Alcohol abuse Yes 48 Not available
    No 834
    Injection drug use Yes 17 Not available
    No 865
    Diabetes mellitus Yes 159 Not available
    No 723
    Dementia Yes 73 Not available
    No 809
    Epilepsy Yes 23 Not available
    No 859
    Neuromuscular disease Yes 25 Not available
    No 857
    Immunosuppression Yes 84 Not available
    No 798
    Antibiotic use before presentation Yes 270 Not available
    No 612
    Confusion Yes 90 Not available
    No 792
    Respiratory rate ≥30 breaths/min Yes 195 Not available
    No 687
    Tachypnea Yes 229 Not available
    No 653
    Systolic bloodpressure <90 mmHg Yes 47 Not available
    No 835
    Diastolic bloodpressure ≤60 mmHg Yes 289 Not available
    No 593
    Pulse ≥125 beats/min Yes 144 Not available
    No 738
    Pulse oximetry ≤90% Yes 231 Not available
    No 651
    Arterial pH <7.35 Yes 79 Not available
    No 432
    PaO2 <60 mmHg Yes 220 Not available
    No 291
    PaO2/FiO2 <250 Yes 197 Not available
    No 314
    Hypoxia Yes 406 Not available
    No 476
    Hematocrit <30% Yes 34 Not available
    No 848
    WBC count <4 or >15x10^9 cells/L Yes 305 Not available
    No 577
    ESR >50 Yes 266 Not available
    No 315
    Sodium level <130 mmol/L Yes 102 Not available
    No 780
    Urea level >7 mmol/L Yes 380 Not available
    No 502
    Urea level ≥11 mmol/L Yes 174 Not available
    No 708
    Glucose level ≥14 mmol/L Yes 47 Not available
    No 753
    Albumin level <3.5 g/dL Yes 455 Not available
    No 398
    CRP level >150 mg/L Yes 414 Not available
    No 439
    Multilobar CXR involvement Yes 101 Not available
    No 781
    Pleural effusion Yes 147 Not available
    No 735
    Positive result of Legionella urinary antigen test Yes 19 Not available
    No 828
    Died in the hospital Yes 41 Not available
    No 841
    Died within 30 days after admission Yes 40 Not available
    No 832
    PSI risk class Class I 109 Not available
    Class II 139
    Class III 160
    Class IV 301
    Class V 173
    CURB-65 score Class I 405 Not available
    Class II 238
    Class III 239
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