Evaluation of the performance of CURB-65 with increasing age

Abstract

There has been concern about the performance of CURB-65 in older patients with community-acquired pneumonia (CAP) and that younger patients who subsequently die are initially misclassified as having non-severe CAP. The purpose of this study was to evaluate the effect of age on the performance of CURB-65. We analysed data prospectively, collected in two UK hospitals. Patients were stratified into four age cohorts. Mortality in each cohort was then stratified by CURB-65 score. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating curve (AUROC) were calculated. Four hundred and twenty-eight patients were included. Misclassification of patients who subsequently died as non-severe CAP patients (CURB-65 score of < or =2) increased with increasing age (from 3% in the <65-year cohort to 27% in those aged >85 years). There were no deaths (0/105) in those aged <65 years who had a CURB-65 score of 0 or 1. At the British Thoracic Society cut-off for severe CAP (CURB-65 score of > or =3), CURB-65 performed best in 16-64-year-olds (PPV 0.4, NPV 0.97). The AUROC was significantly higher for the <65-year cohort in comparison with older patients (0.93 vs. 0.7, p <0.05). Clinicians should interpret the CURB-65 score with care in older patients referred to hospital with CAP. In those aged <65 years, however, CURB-65 appears to be able to identify a cohort of patients (CURB-65 score of 0 or 1) with very low mortality.

Prediction of in-hospital death from community-acquired pneumonia by varying CRB-age groups

“…These results are in line with other reports hinting at an inferiorto-unacceptable operative performance of C(U)RB criteria [5,10] and C(U)RB-65 in elderly patients [4,11]. For example, PARSONAGE et al [11] found CURB-65 to be unreliable for the prediction of low risk in elderly patients, with mortality reaching 27% in the low-risk category in patients aged o80 years.…”

“…For example, PARSONAGE et al [11] found CURB-65 to be unreliable for the prediction of low risk in elderly patients, with mortality reaching 27% in the low-risk category in patients aged o80 years. In another study by CHEN et al [4] including in-and outpatients, the performance of both severity scores (CURB-65 and PSI) became significantly inferior with growing age: AUCs for CURB-65 were 0.80 (95% CI 0.67-0.93), 0.73 (95% CI 0.65-0.82) and 0.60 (95% CI 0.47-0.73) in the younger adult, elderly and very old patients, respectively.…”

Short-term mortality of adult inpatients with community-acquired pneumonia: external validation of a modified CURB-65 score

“…Two new scoring categories have since been proposed, extending the age and urea criteria to ≥85 years and ≥11 mmol/L, respectively, and with each scoring two points. Both cut-off points are considered to correlate with mortality 9 16 25. Extending the already adopted urea and age criteria allows a simple transition towards the use of the CURB-age score.…”

Prediction of Requirement for Mechanical Ventilation in Community-Acquired Pneumonia with Acute Respiratory Failure: A Multicenter Prospective Study

“…The A-DROP scoring system is a modified version of the CURB-65 and it is reported that performance of CURB-65 in mortality deteriorated with increasing age (≥65 years) [28]. AUC of ROC curves for mortality in A-DROP scoring system in this study, 0.8750 (95% confidence interval: 0.6300–1.0000) in those aged <65 years and 0.6374 (95% confidence interval: 0.3204–0.9544) in those aged ≥65 years, showed a similar trend.…”