Validation of a predictive rule for the management of community-acquired pneumonia

Capelastegui, Alberto; España, Pedro Pablo; Quintana, José M.; I, Areitio; Gorordo, Inmaculada; Egurrola, Mikel; Bilbao, Amaia

doi:10.1183/09031936.06.00062505

Cited by 323 publications

(276 citation statements)

References 29 publications

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“…Only class I of the recalibrated PSI score can therefore be used to identify patients who qualify for outpatient management. Prior validation studies have prospectively evaluated severity scores in different clinical settings and reported high mortality rates particularly in patients of PSI class III or above and CURB65 class 1 or above [10][11][12][13][14][15][16][17]. These studies, however, focused mainly on the overall discriminatory ability of the prediction rules with varying results as expressed by differences in the area under the ROC curves.…”

Section: Discussionmentioning

confidence: 99%

“…With only few exceptions [10], external validation studies of pneumonia severity scores have focused on discriminative properties, i.e. the ability of the score to distinguish patients with CAP and fatal outcome from those surviving [10][11][12][13][14][15][16][17]. Despite good discriminatory abilities, most validation studies found higher mortality rates of patients with PSI class III and CURB65 class 1 than was reported in the original studies.…”

Section: Introductionmentioning

confidence: 99%

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Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings

et al. 2008

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SUMMARYIn patients with community-acquired pneumonia (CAP) prediction rules based on individual predicted mortalities are frequently used to support decision-making for in-patient vs. outpatient management. We studied the accuracy and the need for recalibration of three risk prediction scores in a tertiary-care University hospital emergency-department setting in Switzerland. We pooled data from patients with CAP enrolled in two randomized controlled trials. We compared expected mortality from the original pneumonia severity index (PSI), CURB65 and CRB65 scores against observed mortality (calibration) and recalibrated the scores by fitting the intercept a and the calibration slope b from our calibration model. Each of the original models underestimated the observed 30-day mortality of 11 %, in 371 patients admitted to the emergency department with CAP (8 . 4%, 5 . 5 % and 5 . 0% for the PSI, CURB65 and CRB65 scores, respectively). In particular, we observed a relevant mortality within the low risk classes of the original models (2 . 6%, 5 . 3%, and 3 . 7% for PSI classes I-III, CURB65 classes 0-1, and CRB65 class 0, respectively). Recalibration of the original risk models corrected the miscalibration. After recalibration, however, only PSI class I was sensitive enough to identify patients with a low risk (i.e. <1%) for mortality suitable for outpatient management. In our tertiary-care setting with mostly referred in-patients, CAP risk scores substantially underestimated observed mortalities misclassifying patients with relevant risks of death suitable for outpatient management. Prior to the implementation of CAP risk scores in the clinical setting, the need for recalibration and the accuracy of low-risk re-classification should be studied in order to adhere with discharge guidelines and guarantee patients' safety.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings

et al. 2008

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“…Patients with the most severe pneumonia take the longest to recover and remain in the hospital for longer periods. The current study showed that CURB-65 scores, like the PSI index (24,25), can be used to estimate the duration of hospital stay, just as Capelastegui et al (26) reported. Capelastegui et al (27) also found that factors associated with a longer hospital stay for patients hospitalized with CAP included high risk classification on the PSI.…”

Section: Discussionmentioning

confidence: 91%

Weight of the CURB-65 Criteria for Community-Acquired Pneumonia in a Very Low-Mortality-Rate Setting

Guo

Zhong

et al. 2012

Intern. Med.

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Objective The CURB-65 score is a simple well validated tool for the assessment of severity in communityacquired pneumonia (CAP). The weight of each criterion in very low-mortality-rate settings is unclear. The purpose of this study was to determine the weight in such setting. Methods This study retrospectively reviewed 1,230 adult patients admitted for CAP from 2005 to 2009. Results The 30-day mortality rose sharply from 0%, 1.0%, 8.2% and 16.7%, respectively, for patients with CURB-65 scores of 0, 1, 2 and 3 to 100.0% for patients with the scores of 4 (x 2 = 219.494, p<0.001). Confusion had the strongest association with mortality (odds ratio, 22.148). The presence of low blood pressure was not associated with mortality. Confusion, urea >7 mmol·L -1 and age ! 65 yrs showed independent relationships with mortality (Odds ratio, 11.537, 5.988 and 10.462; respectively). Urea >7 mmol·L --1 was most strongly associated with the sequential organ failure assessment (SOFA) scores [rank correlation coefficient (rs), 0.352]. Confusion had the closest relationship with hospital length of stay (rs, 0.114). Age ! 65 yrs had the strongest association with costs (rs, 0.223). Conclusion The individual CURB-65 criteria were of unequal weight for predicting the 30-day mortality, SOFA scores, hospital length of stay and costs in a very low-mortality-rate setting, and a low blood pressure was not associated with mortality.

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“…Similar a lo descrito por otros autores, los cuatro índices pronósticos (PSI, CURB-65, SMART-COP y SCAP) se relacionaron significativamente con la permanencia en el hospital [29][30][31][32] . De hecho, las categorías de alto riesgo se asociaron a estancia prolongada en el hospital (Tabla 5).…”

Section: Discussionunclassified

Evaluación de los índices predictores de eventos adversos en el adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad

et al. 2017

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Validation of a predictive rule for the management of community-acquired pneumonia

Cited by 323 publications

References 29 publications

Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings

Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings

Weight of the CURB-65 Criteria for Community-Acquired Pneumonia in a Very Low-Mortality-Rate Setting

Evaluación de los índices predictores de eventos adversos en el adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad

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