Predictive value of community-acquired pneumonia severity scores on lung cancer patients with immune checkpoint inhibitor-associated pneumonitis: a retrospective analysis

Abstract

Introduction: The immune checkpoint inhibitor-associated pneumonitis (CIP) is a potentially fatal type of immune-related adverse events. There is urgent need for objective and consistent assessment tools for evaluating the severity of CIP. Several severity scores of community-acquired pneumonia (CAP) might meet the need. Methods: A retrospective study was conducted to explore preliminarily if several CAP severity scores including Pneumonia Severity Index (PSI), CURB65, CRB65 and SMART-COP, could predict the mortality in lung cancer patients with CIP. Results: A total number of 53 lung patients with CIP were included, which were divided into two groups according to each severity score respectively. Patients with higher severity score were more likely to have severe CIP, higher C-reactive protein and D-dimer, and receive corticosteroids treatment. Mortality was significantly higher in the high CURB65 group than in the low CURB65 group (30-day: 28.6% vs 2.6%; 90-day: 35.7% vs 7.7%; 180-day:42.9% vs 18.00%), as well as in the high SMART-COP group compared to the low SMART-COP group (30-day: 27.8% vs 0; 90-day: 27.8% vs 8.6%; 180-day:38.9% vs 17.1%). The PSI, SMART-COP and CURB65 were moderately correlated with American Society of Clinical Oncology (ASCO) grade of CIP respectively. Conclusion: Both CURB65 and SMART-COP accurately stratified the risk of mortality in lung cancer patients with CIP. They might complement the ASCO grade in the assessment and prediction of mortality in these population.