Validity of CURB-65 in Predicting Mortality and ICU Admission in HIV-Positive Patients With Community Acquired Pneumonia

Olfert, Jordan; Skinner, Stuart

doi:10.1378/chest.1390568

Cited by 3 publications

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“…In the only prior study formally evaluating the CURB65 score it underestimated mortality and the requirement for ICU admission as HIV-infected patients had more than twice as high mortality and twice as long hospital and ICU stays compared with HIV-uninfected patients despite similar CURB65 scores. 39 While reasons for this discrepant performance of the CURB65 score between HIV-infected and HIV-uninfected adults are not clear, the age factor seems less important in typically younger HIV-infected patients, whose biological ages are reportedly 10–14 years advanced. 40–42 There are two possible non-exclusive explanations for the lack of correlation between NP colonisation density and the Pitt bacteraemia score.…”

Section: Discussionmentioning

confidence: 99%

Pneumococcal colonisation density: a new marker for disease severity in HIV-infected adults with pneumonia

et al. 2014

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ObjectiveA high genomic load of Pneumococcus from blood or cerebrospinal fluid has been associated with increased mortality. We aimed to analyse whether nasopharyngeal colonisation density in HIV-infected patients with community-acquired pneumonia (CAP) is associated with markers of disease severity or poor outcome.MethodsQuantitative lytA real-time PCR was performed on nasopharyngeal swabs in HIV-infected South African adults hospitalised for acute CAP at Chris Hani Baragwanath Hospital, Soweto, South Africa. Pneumonia aetiology was considered pneumococcal if any sputum culture or Gram stain, urinary pneumococcal C-polysaccharide-based antigen, blood culture or whole blood lytA real-time PCR revealed pneumococci.ResultsThere was a moderate correlation between the mean nasopharyngeal colonisation densities and increasing CURB65 scores among all-cause patients with pneumonia (Spearman correlation coefficient r=0.15, p=0.06) or with the Pitt bacteraemia score among patients with pneumococcal bacteraemia (p=0.63). In patients with pneumococcal pneumonia, nasopharyngeal pneumococcal colonisation density was higher among non-survivors than survivors (7.7 vs 6.1 log10 copies/mL, respectively, p=0.02) and among those who had pneumococci identified from blood cultures and/or by whole blood lytA real-time PCR than those with non-bacteraemic pneumococcal pneumonia (6.6 vs 5.6 log10 copies/mL, p=0.03). Nasopharyngeal colonisation density correlated positively with the biomarkers procalcitonin (Spearman correlation coefficient r=0.37, p<0.0001), proadrenomedullin (r=0.39, p=0.008) and copeptin (r=0.30, p=0.01).ConclusionsIn addition to its previously reported role as a diagnostic tool for pneumococcal pneumonia, quantitative nasopharyngeal colonisation density also correlates with mortality and prognostic biomarkers. It may also be useful as a severity marker for pneumococcal pneumonia in HIV-infected adults.

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Section: Discussionmentioning

confidence: 99%

Pneumococcal colonisation density: a new marker for disease severity in HIV-infected adults with pneumonia

et al. 2014

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“…18,20 However, a Canadian group found that CURB-65 may underestimate mortality in this group and advised against using CURB-65 altogether. 21 An American group applied a scoring system called the Veterans Aging Cohort Study (VACS) Index with specific focus on older HIV-positive individuals (age ≥ 50) and 30-day mortality, length of stay and readmission. Other than age, this scoring system is comprised of completely different components than CURB-65 and PSI, including CD4 cell count and viral load.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of hospital admissions for pneumonia in HIV-positive individuals in Winnipeg, Manitoba: a cross-sectional retrospective analysis

et al. 2017

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Lung infection in human immunodeficiency virus (HIV)-positive individuals remains an important cause of morbidity and mortality, even in the current antiretroviral therapy era. Pneumonia is the most common cause of admission in HIV-positive individuals in our centre as reported in a previously published study. The objective of this retrospective observational study was to further characterize these admissions, with respect to index of disease severity at presentation, organisms identified, and investigations pursued including bronchoalveolar lavage (BAL). There were 123 unique patients accounting for a total of 209 admissions from 2005 to 2015. An organism was isolated in only 33% of all admissions (68/209). The most common organism was Pneumocystis jirovecii with a frequency of 29% of all admissions. Eighty-seven percent of presentations were mild, and 13% were moderate by CURB-65 criteria. A total of 39 BALs were performed, of which 27 yielded an organism (69%). Considering the burden of disease, low diagnostic yield of the current diagnostic strategy and increased morbidity and mortality caused by pneumonia in HIV-positive individuals, further methods are needed to more accurately target therapy. The preponderance of mild disease in this study suggests that better diagnostic tests may identify individuals that can be candidates for outpatient therapy.

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“…Many respiratory severity scores that use clinical and laboratory data have been developed to risk stratify and predict outcomes of patients hospitalized with pneumonia including the Pneumonia Severity Index (PSI) and CURB-65 scores [ 2 – 5 ]. Although these scores are used frequently in clinical practice, including in South Africa, they were developed and validated among HIV-uninfected adults in high income settings and may therefore underestimate mortality risk in HIV-infected adults in resource-limited settings [ 6 ]. Several respiratory severity scores have been developed for hospitalized HIV-infected adults and children [ 7 – 9 ], but they are not widely used or have not been prospectively validated to date.…”

Section: Introductionmentioning

confidence: 99%

Development of a respiratory severity score for hospitalized adults in a high HIV-prevalence setting—South Africa, 2010–2011

et al. 2017

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BackgroundAcute lower respiratory tract infections (LRTI) are a frequent cause of hospitalization and mortality in South Africa; however, existing respiratory severity scores may underestimate mortality risk in HIV-infected adults in resource limited settings. A simple predictive clinical score for low-resource settings could aid healthcare providers in the management of patients hospitalized with LRTI.MethodsWe analyzed 1,356 LRTI hospitalizations in adults aged ≥18 years enrolled in Severe Acute Respiratory Illness (SARI) surveillance in three South African hospitals from January 2010 to December 2011. Using demographic and clinical data at admission, we evaluated potential risk factors for in-hospital mortality. We evaluated three existing respiratory severity scores, CURB-65, CRB-65, and Classification Tree Analysis (CTA) Score assessing for discrimination and calibration. We then developed a new respiratory severity score using a multivariable logistic regression model for in-hospital mortality and assigned points to risk factors based on the coefficients in the multivariable model. Finally we evaluated the model statistically using bootstrap resampling techniques.ResultsOf the 1,356 patients hospitalized with LRTI, 101 (7.4%) died while hospitalized. The CURB-65, CRB-65, and CTA scores had poor calibration and demonstrated low discrimination with c-statistics of 0.594, 0.548, and 0.569 respectively. Significant risk factors for in-hospital mortality included age ≥ 45 years (A), confusion on admission (C), HIV-infection (H), and serum blood urea nitrogen >7 mmol/L (U), which were used to create the seven-point ACHU clinical predictor score. In-hospital mortality, stratified by ACHU score was: score ≤1, 2.4%, score 2, 6.4%, score 3, 11.9%, and score ≥ 4, 29.3%. Final models showed good discrimination (c-statistic 0.789) and calibration (chi-square 1.6, Hosmer-Lemeshow goodness-of-fit p-value = 0.904) and discriminated well in the bootstrap sample (average optimism of 0.003).ConclusionsExisting clinical predictive scores underestimated mortality in a low resource setting with a high HIV burden. The ACHU score incorporates a simple set a risk factors that can accurately stratify patients ≥18 years of age with LRTI by in-hospital mortality risk. This score can quantify in-hospital mortality risk in an HIV-endemic, resource-limited setting with limited clinical information and if used to facilitate timely treatment may improve clinical outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-017-0368-8) contains supplementary material, which is available to authorized users.

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Validity of CURB-65 in Predicting Mortality and ICU Admission in HIV-Positive Patients With Community Acquired Pneumonia

Cited by 3 publications

References 0 publications

Pneumococcal colonisation density: a new marker for disease severity in HIV-infected adults with pneumonia

Pneumococcal colonisation density: a new marker for disease severity in HIV-infected adults with pneumonia

Characteristics of hospital admissions for pneumonia in HIV-positive individuals in Winnipeg, Manitoba: a cross-sectional retrospective analysis

Development of a respiratory severity score for hospitalized adults in a high HIV-prevalence setting—South Africa, 2010–2011

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