Improvement of CRB-65 as a prognostic tool in adult patients with community-acquired pneumonia

Abstract

BackgroundPatients with community-acquired pneumonia (CAP) often require hospitalisation. CRB-65 is a simple and useful scoring system to predict mortality. However, prognostic factors such as underlying disease and blood oxygenation are not included despite their potential to increase the performance of CRB-65.MethodsThe study included 1172 consecutive patients (830 inpatients, 342 outpatients) with CAP. Mortality, sensitivity, specificity, positive predictive value and negative predictive value, and the area under the receiver operating characteristic (ROC) curve with 95% CI were calculated. Prognostic accuracy was evaluated after adding coexisting illnesses according to the Pneumonia Severity Index (malignancy, heart failure, hepatic, renal and cerebrovascular disease) and pulse oximetry (SpO2).ResultsMean age was 65 years, 30-day mortality 7% (inpatients 9%, outpatients 1%). Addition of one point for the presence of ≥1 coexisting condition and one point for SpO2 <90% increased the area under the ROC curve of CRB-65 from 0.82 (95% CI 0.77 to 0.85) to 0.87 (95% CI 0.84 to 0.90; p<0.0001).ConclusionsModification of CRB-65 by including hypoxaemia and presence of specified underlying diseases increased the scoring system’s prognostic accuracy while retaining its independence of laboratory tests. DS CRB-65 may have the potential to further facilitate site of care decision for patients with CAP.

Functional status and mortality prediction in community‐acquired pneumonia

“…The predictive value of the CRB‐65 score, however, is not optimal . Hence, there have been continuous efforts to improve the CRB‐65 score by adding easily obtainable parameters such as the presence of chronic co‐morbidities or oxygenation assessment …”

“…7,8 Hence, there have been continuous efforts to improve the CRB-65 score by adding easily obtainable parameters such as the presence of chronic co-morbidities or oxygenation assessment. [9][10][11] In recent years, several studies have recognized the prognostic importance of functional status (FS) in elderly patients. [12][13][14][15] Moreover, severely limited premorbid FS was associated with mortality in a population-based cohort of patients with severe pneumonia.…”

Behandling av pneumoni oppstått utenfor sykehus

“…CRB-65kriteriene er vist å vaere bedre enn SIRS til å identifisere pasienter med pneumoni med lav mortalitet som kan behandles utenfor sykehus. Det diskuteres imidlertid om pasienter med lav CRB-65-skår, men høy grad av komorbiditet eller hypoksemi, bør vurderes innlagt, og om CRB-65-kriteriene derfor ikke er optimale for å vurdere alvorlighetsgrad og prognose (12,13). Andre studier har sammenlignet CRB-65-kriteriene med SIRS i tillegg til de nye sepsiskriteriene, quick sepsis-related organ failure assessment (qSOFA) (14).…”

Assessment of oxygenation and comorbidities improves outcome prediction in patients with community‐acquired pneumonia with a low CRB‐65 score

“…Based on recent studies, improvement of the CRB‐65 score by the addition of two easily obtainable parameters such as the presence of chronic comorbidities and oxygenation assessment has been suggested . Thus, a ‘D’‐criterion (diseases: 1 point for the presence of a defined extra‐pulmonary comorbidity) and an ‘S’‐criterion (saturation of oxygen: 1 point for oxygen saturation < 90%) have been added to the CRB‐65 criteria . The resulting DS‐CRB‐65 score may combine the advantages of providing a superior NPV for poor outcomes together with easy accessibility, as no additional laboratory measurements are needed and implementation in an ambulatory setting seems feasible.…”