BACKGROUND: Several predictive scoring systems have been developed to improve the clinical management of patients with community-acquired pneumonia (CAP) and optimise resource allocation. None of the current scores have been validated for immunosuppressed patients and data on outcome of CAP in solid organ transplant recipients are scarce. What is the predictive value of pneumonia severity scores in solid organ transplant recipients with CAP?

STUDY DESIGN AND METHODS: We retrospectively analysed 333 first CAP episodes after lung, kidney and liver transplantation between 1 January 2010 and 31 May 2021. We assessed clinical outcomes and evaluated six risk scores (CRB-65 (confusion, respiratory frequency ≥30 breaths·min -1, systolic blood pressure <90 mmHg or diastolic blood pressure ≤60 mmHg and age ≥65 years); CURB-65 (confusion, urea >7 mol·L -1, respiratory frequency ≥30 breaths·min -1, systolic blood pressure <90 mmHg or diastolic blood pressure ≤60 mmHg and age ≥65 years); qSOFA (Quick Sepsis-Related Organ Failure Assessment); SOFA; Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) 2007 minor criteria; and the National Early Warning Score 2 (NEWS2)) for the prognosis of severe pneumonia (admission to intensive care unit) and in-hospital mortality. Risk scores were assessed in the first 24 h after admission.

RESULTS: None of the scores showed adequate prognostic values to guide clinical management of patients in our cohort. The IDSA/ATS 2007 minor criteria, SOFA and NEWS2 performed best in predicting both severe pneumonia and in-hospital mortality, with area-under-the-curve values between 0.72 and 0.67.

CONCLUSION: This comprehensive analysis of CAP in solid organ transplant recipients emphasises the complexity of managing this population and the need for transplant-specific risk assessment tools to improve patient management.