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

Abstract

C(U)RB-65 (confusion, (urea .7 mol?L -1 ,) respiratory frequency o30 breaths?min -1 , systolic blood pressure ,90 mmHg or diastolic blood pressure f60 mmHg and age o65 years) is now the generally accepted severity score for patients with community-acquired pneumonia (CAP) in Europe.In an observational study based on the large database from the German nationwide performance measurement programme in healthcare quality, including data from all hospitalised patients with CAP during 2008-2010, different CRB-age groups (o50 and o60 years) across the total CAP population and three entities of CAP (younger population aged ,65 years, patients aged o65 years not residing in nursing homes and those with nursing home-acquired pneumonia (NHAP)) were validated for their potential to predict in-hospital death.660 594 patients were investigated. Mortality was n593 958 (14.0%). In the total population, CRB-80 had the optimal area under the curve (0.690, 95% CI 0.688-0.691). However, in the younger cohort, CRB-50 performed best (0.730, 95% CI 0.724-0.736), with good identification of low-risk patients (CRB-50 risk class 1: 1.28% deaths, negative predictive value 98.7%). In the elderly, CRB-80 as the optimal age group performed worse (0.663, 95% CI 0.660-0.655 in patients not residing in nursing homes; 0.608, 95% CI 0.605-0.611 in those with NHAP). In the latter group, all CRB-age groups failed to identify low-risk patients (CRB-80 risk class 1: 22.75% deaths, negative predictive value 81.8%).Patients with hospitalised CAP aged ,65 years may be assessed by the CRB-50 score. In those aged o65 years (not NHAP) assessed by the CRB-65 score, low-risk patients are already are at an increased risk of death. In NHAP patients, even the use of CRB-80 does not identify low-risk patients and should be accompanied by the evaluation of functional status and comorbidity.

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.…”

Management-based risk prediction in community-acquired pneumonia by scores and biomarkers

“…Established risk stratification tools like the CRB-65 and PSI scores work less well in elderly and severely disabled patients, but can be significantly improved by including oxygenation measurement and assessment of functional status [47][48][49][50]. A recent population-based study from Germany showed that especially the negative predictive value of the CRB-65 score for mortality in nursing home patients is insufficient as hospital mortality of identified ''low risk'' patients was still about 20%, but prediction could be improved by the evaluation of functional status (''bedridden'') and comorbidities [50].…”

Interleukin-6 and procalcitonin as biomarkers in mortality prediction of hospitalized patients with community acquired pneumonia

“…[2345678910] Most of the patients were males, average age 63.7 years, smokers with co-morbidities. Over 88% of investigated patients had co-morbidity, mainly cardiovascular (53.4%).…”

“…Major risk scores (PSI, CURB65) have shown to be significant advance in prediction of mortality due to CAP. [123456789] However, there are some important issues with the risk scores. PSI is more suitable for identification of low risk patients benefiting from outpatient treatment whereas CURB65 improves identification of high risk patients.…”