PERBANDINGAN AKURASI SCORE CURB-65, PSI, DAN SMART-COP DALAM MEMPREDIKSI KEBUTUHAN VENTILASI MEKANIS DAN MORTALITAS PADA PASIEN PNEUMONIA KOMUNITAS DI PERAWATAN INTENSIF RS WAHIDIN SUDIROHUSODO = Comparative Accuracy of CURB-65, PSI, and SMART-COP for Predicting Mechanical Ventilation and Mortality in Community-Acquired Pneumonia

Objective: To compare the accuracy of CURB-65, Pneumonia Severity Index (PSI), and SMART-COP in predicting mechanical ventilation requirement and intensive care unit (ICU) mortality among patients with community-acquired pneumonia (CAP) admitted to the ICU. Design: Retrospective observational study. Setting: Intensive Care Unit of Dr. Wahidin Sudirohusodo Hospital, a national referral tertiary-care hospital in Indonesia. Patients and Participants: Adult patients (≥18 years) admitted to the ICU with a primary diagnosis of CAP between January and December 2024 were screened. Of 387 ICU admissions, 181 patients met the inclusion criteria and were analyzed. Patients were categorized according to mechanical ventilation requirement and ICU mortality. Interventions: No therapeutic intervention was applied. Severity stratification at ICU admission was performed using CURB-65, PSI, and SMART-COP scores based on available clinical, laboratory, and radiographic data. Measurements and Results: The primary outcomes were mechanical ventilation requirement and ICU mortality. Associations between severity categories and outcomes were assessed using chi-square tests. Predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis. Mechanical ventilation was required in 53.0% of patients, and ICU mortality was 47.5%. All three scores were significantly associated with both outcomes (p < 0.05). For predicting mechanical ventilation, SMART-COP demonstrated the highest discriminatory ability (AUC 0.856), followed by PSI (AUC 0.818) and CURB-65 (AUC 0.764). For predicting ICU mortality, PSI showed the highest accuracy (AUC 0.892), compared with SMART-COP (AUC 0.838) and CURB-65 (AUC 0.823). Conclusions: In ICU patients with CAP, SMART-COP provides superior prediction of mechanical ventilation requirement, whereas PSI demonstrates the best performance for ICU mortality prediction. Selection of severity scores should be tailored to specific clinical endpoints to improve risk stratification and support critical care decision-making.