Risk Prediction Models for Mortality in Community-Acquired Pneumonia: A Systematic Review

Abstract

Background. Several models have been developed to predict the risk of mortality in community-acquired pneumonia (CAP). This study aims to systematically identify and evaluate the performance of published risk prediction models for CAP. Methods. We searched MEDLINE, EMBASE, and Cochrane library in November 2011 for initial derivation and validation studies for models which predict pneumonia mortality. We aimed to present the comparative usefulness of their mortality prediction. Results. We identified 20 different published risk prediction models for mortality in CAP. Four models relied on clinical variables that could be assessed in community settings, with the two validated models BTS1 and CRB-65 showing fairly similar balanced accuracy levels (0.77 and 0.72, resp.), while CRB-65 had AUROC of 0.78. Nine models required laboratory tests in addition to clinical variables, and the best performance levels amongst the validated models were those of CURB and CURB-65 (balanced accuracy 0.73 and 0.71, resp.), with CURB-65 having an AUROC of 0.79. The PSI (AUROC 0.82) was the only validated model with good discriminative ability among the four that relied on clinical, laboratorial, and radiological variables. Conclusions. There is no convincing evidence that other risk prediction models improve upon the well-established CURB-65 and PSI models.

Predicting the Risk of Readmission in Pneumonia. A Systematic Review of Model Performance

“…None of the studies included in this review incorporated the Pneumonia Severity Index or the CURB-65 score, which are strong predictors of mortality and have also been shown to be associated with hospital readmissions (11,(20)(21)(22)(23)(24). Furthermore, the only study that included measures of in-hospital clinical trajectory and stability on discharge, robust predictors of postdischarge adverse outcomes, had very good discrimination (C statistic of 0.77); however, because of the study's low quality due to limited generalizability, incomplete ascertainment of readmissions, and lack of validation, it is unclear whether inclusion of these measures improved readmission risk prediction (11,23,(25)(26)(27).…”

Exploratory mixed methods study of respiratory physiotherapy for patients with lower respiratory tract infections

“…Eligibility criteria were: age ≥18 years and diagnosed with LRTI by a physician, in accordance with current guidelines [3]. Exclusion criteria were: (a) hospital admission (following examination by a physician); (b) discrepancies in speech and/or disorientation at the initial examination; (c) bedridden or dependence on a wheelchair; (d) score >2 on the CURB criteria [15]; and (e) the presence of comorbidities that could interfere with the tests performed (e.g. past history of pulmonary lobectomy and current history of neoplasia, tuberculosis or other infectious disease).…”

Predictive value of severity scores in community acquired pneumonia

“…Evaluar la gravedad y el riesgo de muerte de los pacientes con NAC admitidos en los servicios de atención médica mediante escalas pronósticas como el CURB 65 y PSI es un paso inevitable que ayuda al Internista a decidir el lugar de hospitalización, 11,28 extensión del estudio etiológico y el tratamiento empírico, cuya utilidad ha sido analizada en otros estudios .…”