Comparative study of CURB-65, Pneumonia Severity Index and IDSA/ATS scoring systems in community acquired pneumonia in an Indian tertiary care setting

Abstract

Background: Few comparative studies regarding prognostic scoring systems for community acquired pneumonia (CAP) are available from Indian context.Methods: Hospital-based prospective study to test the comparison between confusion, urea, respiratory rate, blood pressure, age over 65 years (CURB-65), Pneumonia severity index (PSI) and infectious diseases society of America/American thoracic society criteria (IDSA/ATS) scoring systems in patients with community acquired pneumonia.Results: CURB-65 class ≥III, PSI class ≥IV and patients who needed admission to intensive care unit (ICU) based on IDSA/ATS criteria were having sensitivity of 41.7%, 91.7% and 87.5% in predicting ICU admission with a specificity of 89.5%, 59.2% and 73.7% respectively. Their sensitivity in predicting death were 44.4%, 88.9% and 83.3% with a specificity of 87.8%, 54.9% and 68.3% respectively. In both PSI score and IDSA/ATS criteria risk scoring systems, mortality rate, need for ICU admission increased progressively with increasing scores but CURB-65 score did not show this correlation. The PSI class ≥IV was more sensitive in predicting ICU admission than CURB-65 and IDSA/ATS criteria.Conclusions: PSI was most sensitive in both predicting ICU admission and death whereas CURB-65 is most specific in predicting ICU admission and death. But CURB-65 is least sensitive in both predicting ICU admission and death. Even though IDSA/ATS criteria did not have highest sensitivity and specificity as single criteria it had modest sensitivity and specificity in predicting ICU admission and death.

Confusion, blood urea, respiration and blood pressure 65, pneumonia severity index and shock index and hypoxemia scores in community acquired pneumonia and outcome prediction: a descriptive study from Dr B R Ambedkar Memorial Hospital Raipur, India

“…4 In contrast, study by Madhu S. et al reported that mortality was increased gradually with increase in PSI severity score but mortality was present even in PSI 1 and 2 class which was not there in this study. 3 In present study, maximum diagnostic value was noted with PSI score followed by CURB 65 and SIPF score. PSI score had diagnostic cut off of 152.5 with sensitivity of 94.4% and specificity of 100% while CURB 65 showed diagnostic cut off of 2.5 with sensitivity of 83.1% and specificity of 100%.…”

“…[9][10][11][12] In this study (8.2%) subjects belonged to >70 years age which was in accordance with the study by GC Mbata et al, and Madhu S. et al, in which (33.7%) and (29%) of patients were above 65 years of age respectively. 3,13 In present study, (56.1%) patients were females and (43.9%) were males. The gender distribution was in accordance with the study by GC Mbata et al, in which 48.8% patients were males and 51.2 % patients were females.…”

“…The mortality rate was 6.8%, 18%, 15% respectively in studies by Ewig S et al, Madhu S et al, and GC Mbata et al, respectively. 3,13,14 In a study by Bansal S et al, mortality was (11%) and patients were particularly elderly people. 11 However, study by Madhu S et al, reported mortality of (18%) showing the need of a good prognostic index.…”

“…2 According to WHO, pneumonia is the third important cause of death worldwide in spite of various advances in medical science. 3 Incidence of Community acquired pneumonia is about 20% to 30% in developing countries compared to 3% to 4 % in developed countries. Incidence of CAP is much higher in the very young and the elderly individuals.…”

Profil Pasien dan Penggunaan Antibiotik pada Kasus Community-Acquired Pneumonia Rawat Inap di Rumah Sakit Akademik wilayah Sukoharjo

“…Namun pada penelitian ini pasien dengan tingkat "Ringan" mendapatkan perawatan di rawat inap. Hal tersebut didukung dengan penelitian yang menemukan adanya mortalitas pada tingkat keparahan "Ringan" sehingga perawatan di rumah sakit diperlukan agar dapat mengurangi angka mortalitas pneumonia (Madhu et al, 2017 Kombinasi keduanya sama efektifnya dengan pemberian tunggal levofloxacin (Izadi et al, 2018). Ceftriaxone memiliki efek bakterisidal dengan menghambat sintesis mukopeptida dinding sel bakteri (Rawls, 2014).…”