A new predictive tool consolidating CURB-65 with procalcitonin and albumin to assess short-term mortality in hospitalized elderly patients with infectious disease: A retrospective study of a patient cohort

Abstract

Background: Hospitalized elderly patients are often at risk of life-threatening infectious diseases such as pneumonia and urinary tract infection, thus diagnostic tools for bacterial infections are demanded. We developed a new predictive tool consolidating modified CURB-65, procalcitonin (PCT) and albumin (Alb). Method: This is a retrospective study. Modified CURB-65 (mCURB-65) score, PCT, Alb, and various cardiovascular/respiratory/renal functions were measured. Survival analyses were conducted to assess 30-days mortality of elderly patients using mCURB-65 score, PCT and Alb. The consolidated scores were compared with the number of patients died. Results: There were 445 elderly patients included. Kaplan–Meier survival curves showed significant differences between the high and low groups of mCURB-65, PCT and Alb (log-rank test, P < .001). Cox proportional regression showed that the hazard ratios (95% confidence intervals) for high mCURB-65, high Alb, and high PCT were all significant, 1.95 (1.24–3.05), 0.50 (0.32–0.77), and 2.09 (1.32–3.31), respectively. The consolidated scores showed tendency of increase with proportion of the number of patients died. Conclusions: The consolidated score consisted of mCURB-65, PCT and Alb can be a useful tool to predict short-term mortality of the hospitalized elderly patients with infectious disease.

Influence of Nutritional Parameters on the Evolution, Severity and Prognosis of Critically Ill Patients with COVID-19

“…Decreased albumin levels are associated with an increased risk of acute respiratory failure and increased frequency of mechanical ventilation [53]. An association of albumin with mortality was also found in other studies; in COVID-19 patients [54], hip fracture patients [55,56], patients with infectious diseases [57], newborn patients [58], the lactate-to-albumin ratio in patients with acute myocardial infarction [59], the albumin-bilirubin score in patients with hypertrophic cardiomyopathy [60], a combined index of hemoglobin, albumin, lymphocyte, and platelet in patients with acute exacerbations of chronic obstructive pulmonary disease [61], and the albumin-to-prealbumin ratio in hemodialysis patients [62]. In malnourished patients, atrophy of the diaphragmatic muscle and loss of muscle mass can occur, in addition to a deterioration of the immune response, which leads to an increased risk of pneumonia.…”

Predicting mortality among patients with severe COVID-19 pneumonia based on admission vital sign indices: a retrospective cohort study

“…In contrast, the CURB-65 score has poorer specificity in older adults, and adding the “age of above/below 65” criterion to CURB does not increase its sensitivity or specificity in hospitalized patients [ 29 ]. CURB-65 was modified to CURB-age [ 11 ], expanded CURB-65 [ 30 ], and modified CURB-65 [ 31 ] for better prognostic performance. During the COVID-19 pandemic, CURB-65 was used as a prognostic predictor.…”

Procalcitonin, brain natriuretic peptide and albumin as markers to predict prognosis in hospitalized older Japanese patients with a risk of infection

“…8,9 We previously reported that the combination of PCT and Alb can predict 30-day mortality. 10 A number of biomarkers associated with heart failure have also been well recognized, and measuring their concentrations in circulation can be a convenient and noninvasive approach to provide important information about disease severity, and helps in the detection, diagnosis, prognosis and management of heart failure, including PCT, brain natriuretic peptide (BNP) and others. 11 PCT concentrations >2 ng/mL are frequently found in cardiogenic shock patients with multiple organ failure, but a PCT concentration of ≥10 ng/mL seems to be more appropriate for diagnosing this complication in cardiogenic shock patients than 2 ng/mL, which suggests that PCT can be a predictive biomarker not only for infectious disease, but also for prediction of prognosis of shock patients.…”

“…In addition to PCT, albumin (Alb) has also been known to be one of the risk factors for bacterial infectious diseases, such as surgical site infection and aspiration pneumonia 8,9 . We previously reported that the combination of PCT and Alb can predict 30‐day mortality 10 …”