Expanded A-DROP Score Accurately Predicts 14-Day Mortality, ICU Admission in Community-Acquired Pneumonia: Study
India: A study published in the Journal of the Association of Physicians of India (JAPI) has found that the Expanded A-DROP score can accurately predict short-term mortality, intensive care unit (ICU) admission, and length of hospital stay among patients with community-acquired pneumonia (CAP). The findings suggest that the scoring system may serve as a practical tool for early risk assessment and clinical decision-making, particularly in resource-constrained healthcare settings.
The study was conducted by Reshma Prakash, 3rd Year Postgraduate Resident, Department of General Medicine, Dr Ram Manohar Lohia Hospital, Delhi, India, and colleagues.
Community-acquired pneumonia remains a major cause of illness and death worldwide. Although commonly used prognostic tools such as CURB-65, A-DROP, and the Pneumonia Severity Index (PSI) help assess disease severity, each has certain limitations. The Expanded A-DROP score builds on existing models by incorporating additional clinical and biochemical parameters that may better reflect the overall severity of illness. However, evidence supporting its use in Indian patients has been limited.
To evaluate its clinical utility, researchers conducted a prospective observational study between March 2024 and June 2025. The study enrolled 80 adult patients diagnosed with community-acquired pneumonia. Expanded A-DROP scores were calculated within 24 hours of hospital admission, and patients were monitored for ICU admission, in-hospital outcomes, and mortality up to 14 days after discharge.
Key findings of the study include:
- Of the 80 patients with community-acquired pneumonia, 22 (27.5%) died within 14 days.
- Mortality increased significantly with higher Expanded A-DROP scores, rising from 4.3% in patients with scores of 0–2 to 9.1% in those with scores of 3–4 and 54.3% in those with scores ≥5.
- ICU admission rates also increased with disease severity, from 4.3% in the lowest-risk group to 36.4% in the intermediate-risk group and 71.4% in the highest-risk group.
- Higher Expanded A-DROP scores were associated with longer hospital stays.
- The mean duration of hospitalization increased from 4 days in the low-risk group to 7 days in the intermediate-risk group and 9 days in the high-risk group.
- A significant positive correlation was observed between Expanded A-DROP score and length of hospital stay.
- ROC analysis demonstrated strong predictive accuracy for 14-day mortality, with an AUC of 0.871.
- An Expanded A-DROP score of ≥5 predicted 14-day mortality with 86.2% sensitivity and 72.4% specificity.
- Multivariable analysis identified the Expanded A-DROP score as the sole independent predictor of mortality.
The investigators acknowledged limitations such as the single-center design, relatively small sample size, limited representation of some high-risk patient groups, lack of serial biomarker measurements, absence of direct comparison with CURB-65, and the focus on short-term outcomes without extended follow-up.
The researchers concluded that the Expanded A-DROP score provides a reliable and clinically useful method for assessing pneumonia severity. By incorporating renal, cardiac, and oncological risk factors alongside routine clinical and laboratory parameters, the tool may support early triage, ICU allocation, resource planning, and post-discharge monitoring in patients with community-acquired pneumonia.
Reference:
Prakash R, Sinha N, Goyal P. Role of Expanded A-DROP Score in Predicting 14-day Mortality in Patients with Community-acquired Pneumonia: A Prospective Observational Study from a Tertiary Care Center in North India. J Assoc Physicians India 2026;74(6):16–21.
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