The Performance of CURB-65 and PSI for Predicting In-Hospital Mortality of Community-Acquired Pneumonia in Patients with Type 2 Diabetes Compared with the Non-Diabetic Population

Abstract

Objective: To compare the performance of CURB-65 and Pneumonia Severity Index (PSI) for predicting in-hospital mortality of community-acquired pneumonia (CAP) between patients with and without type 2 diabetes (T2DM). Methods: A retrospective study was conducted on 2365 CAP patients in The First Hospital of Qinhuangdao, China. The primary outcome was in-hospital mortality. The area under curves (AUCs) was used to evaluate the abilities of CRB-65, CURB-65, and PSI class for predicting in-hospital mortality in patients with CAP. Results: Among CAP patients, 127 patients (5.4%) died, 80 patients were without diabetes, and 47 patients had T2DM. In-hospital mortality increased with the risk stratification defined as CURB-65 and PSI class in both non-diabetes and T2DM patients (P<0.05). The AUCs for predicting in-hospital mortality were 0.728～0.798 in patients without T2DM (CRB-65: 0.728, CURB-65: 0.757 and PSI class: 0.798) and 0.641～0.716 in patients with T2DM (CRB-65: 0.641, CURB-65: 0.677 and PSI class: 0.716)(P<0.001). The AUC of the PSI class was lower in patients with T2DM than in patients without T2DM (P<0.05). Conclusion: CURB-65 and PSI class are correlated with in-hospital mortality of CAP in patients with and without T2DM. Compared with non-diabetes patients, the predictive performance of CURB-65 and PSI class decreased in patients with T2DM. A prediction model for evaluating the CAP severity in the T2DM population should be developed by future studies.

Association of admission blood glucose level and clinical outcomes in elderly community‐acquired pneumonia patients with or without diabetes

“…Nowadays, identifying risk factors of CAP prognosis and mortality may provide basis for timely and effective treatment of patients with CAP. 7 Diabetes mellitus is a highly prevalent chronic metabolic disorder that occurs in approximately 5–10% in the older population. 8 Moreover, with the increase in the prevalence of diabetes, the incidence of CAP also increases significantly.…”

Clinical characteristics and risk factors associated with mortality in patients with severe community-acquired pneumonia and type 2 diabetes mellitus

“…The CURB-65 score, including confusion, urea > 7 mmol/L, respiratory rate ≥ 30 breaths/min, systolic blood pressure < 90 mm Hg or diastolic blood pressure ≤ 60 mm Hg, and age ≥ 65 years, and pneumonia severity index (PSI), including age, nursing home residence, coexisting illnesses, physical examination findings, and laboratory and radiographic findings, are the two most widely used severity scores for pneumonia. However, their accuracy and applicability are decreased in T2DM patients [ 12 ]. Hence, there is an urgent need for novel, reliable and convenient predictive tools.…”

Aspects to Consider for a More Useful, Discriminative Predictive Tool for CAP Mortality in T2DM [Letter]

“…I read with great interest the paper by Ma et al 1 which explored the sensitivity and specificity of using CURB-65 and the PSI scoring systems to predict mortality in type 2 diabetes mellitus (T2DM) patients with community-acquired pneumonia (CAP). The study importantly identified the need for a more specific prediction model in T2DM cohorts.…”