🫁 SMART-COP (CAP Intensive-Support Prediction)
SMART-COP predicts the need for intensive respiratory or vasopressor support (IRVS) in community-acquired pneumonia, with age-adjusted respiratory and oxygenation thresholds.
Unlike CURB-65 (which predicts mortality), SMART-COP predicts the need for intensive organ support, making it more decision-oriented for triage to ICU. (original synthesis · not guideline verbatim)
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
When to use
Enter age, then the eight components; the tool scores 0–11 and bands the IRVS risk. A score ≥ 3 should prompt consideration of high-dependency or ICU evaluation.
How it works
Points: SBP<90 (2), multilobar (1), albumin<35 (1), HR≥125 (1), confusion (1), pH<7.35 (2), tachypnea (≤50 yr ≥25 / >50 yr ≥30: 1), hypoxemia (≤50 yr PaO₂<70/SpO₂≤93/PF<333; >50 yr <60/≤90/<250: 2). Bands: 0–2 low · 3–4 moderate (~1/8) · 5–6 high (~1/3) · ≥7 very high (~2/3).
Key points
- Unlike CURB-65 (which predicts mortality), SMART-COP predicts the need for intensive organ support, making it more decision-oriented for triage to ICU. (original synthesis · not guideline verbatim)
- The respiratory-rate and oxygenation cutoffs differ by age (≤50 vs >50), so the same physiology scores differently in younger patients.
- It is a prediction aid, not a disposition mandate; integrate trajectory, comorbidity, and response to initial therapy.
References
- Charles PG, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in CAP. Clin Infect Dis. 2008;47(3):375-384.
- Metlay JP, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia (ATS/IDSA). Am J Respir Crit Care Med. 2019;200(7):e45-e67.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Age | 60 yr |
|---|---|
| Systolic BP < 90 mmHg | Yes |
| Multilobar involvement on chest X-ray | Yes |
| Albumin < 35 g/L | Yes |
| Respiratory rate | 24 /min |
| Heart rate ≥ 125 bpm | Yes |
| Acute confusion | Yes |
| Oxygenation index type | PaO₂ (mmHg) |
| Oxygenation value | 70 |
| Arterial pH < 7.35 | Yes |
→SMART-COP8/11
- Stratum：Very high risk
- Intensive support (IRVS)：≈ 2 in 3 need IRVS
- Respiratory/oxygenation threshold：>50 yr band
| Age | 60 yr |
|---|---|
| Systolic BP < 90 mmHg | No |
| Multilobar involvement on chest X-ray | No |
| Albumin < 35 g/L | No |
| Respiratory rate | 24 /min |
| Heart rate ≥ 125 bpm | No |
| Acute confusion | No |
| Oxygenation index type | PaO₂/FiO₂ |
| Oxygenation value | 70 |
| Arterial pH < 7.35 | No |
→SMART-COP2/11
- Stratum：Low risk
- Intensive support (IRVS)：Low risk of needing IRVS
- Respiratory/oxygenation threshold：>50 yr band
Frequently asked questions
- What is SMART-COP (CAP Intensive-Support Prediction)?
- SMART-COP predicts the need for intensive respiratory or vasopressor support (IRVS) in community-acquired pneumonia, with age-adjusted respiratory and oxygenation thresholds.
- How is SMART-COP (CAP Intensive-Support Prediction) calculated? What is the core formula?
- Points: SBP<90 (2), multilobar (1), albumin<35 (1), HR≥125 (1), confusion (1), pH<7.35 (2), tachypnea (≤50 yr ≥25 / >50 yr ≥30: 1), hypoxemia (≤50 yr PaO₂<70/SpO₂≤93/PF<333; >50 yr <60/≤90/<250: 2). Bands: 0–2 low · 3–4 moderate (~1/8) · 5–6 high (~1/3) · ≥7 very high (~2/3).
- When is SMART-COP (CAP Intensive-Support Prediction) used?
- Enter age, then the eight components; the tool scores 0–11 and bands the IRVS risk. A score ≥ 3 should prompt consideration of high-dependency or ICU evaluation.
- What are the key clinical points for SMART-COP (CAP Intensive-Support Prediction)?
- Unlike CURB-65 (which predicts mortality), SMART-COP predicts the need for intensive organ support, making it more decision-oriented for triage to ICU. (original synthesis · not guideline verbatim) The respiratory-rate and oxygenation cutoffs differ by age (≤50 vs >50), so the same physiology scores differently in younger patients. It is a prediction aid, not a disposition mandate; integrate trajectory, comorbidity, and response to initial therapy.
- What are the limits and cautions when using SMART-COP (CAP Intensive-Support Prediction)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is SMART-COP (CAP Intensive-Support Prediction) calculated in practice? Can you show a worked example?
- Inputs: Age 60 yr, Systolic BP < 90 mmHg Yes, Multilobar involvement on chest X-ray Yes, Albumin < 35 g/L Yes, Respiratory rate 24 /min, Heart rate ≥ 125 bpm Yes, Acute confusion Yes, Oxygenation index type PaO₂ (mmHg)… → Result: SMART-COP 8 /11（Stratum: Very high risk, Intensive support (IRVS): ≈ 2 in 3 need IRVS, Respiratory/oxygenation threshold: >50 yr band） Inputs: Age 60 yr, Systolic BP < 90 mmHg No, Multilobar involvement on chest X-ray No, Albumin < 35 g/L No, Respiratory rate 24 /min, Heart rate ≥ 125 bpm No, Acute confusion No, Oxygenation index type PaO₂/FiO₂… → Result: SMART-COP 2 /11（Stratum: Low risk, Intensive support (IRVS): Low risk of needing IRVS, Respiratory/oxygenation threshold: >50 yr band）