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

Guo, Qi; Li, Haiyan; Zhong, Yiping; Li, Ming; Chen, Xiaoke; Liu, Hui; Peng, Hong-lin; Yu, Hai-Qiong; Chen, Xia; Liu, Nian; Liu, Liang; Zhao, Qing-zhou; Jiang, Mei

doi:10.2169/internalmedicine.51.8159

Cited by 6 publications

(4 citation statements)

References 28 publications

(23 reference statements)

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“…This can be explained by the omission of the urea criterion, which has been shown to be significantly associated with mortality in CAP patients [7,29-31]. Furthermore, CRB-65 identified fewer patients at low risk than CURB-65 (87 vs. 211), but showed better sensitivity with a resulting even slightly lower mortality in the low-risk group.…”

Section: Discussionmentioning

confidence: 99%

External validation of the CURSI criteria (confusion, urea, respiratory rate and shock index) in adults hospitalised for community-acquired pneumonia

et al. 2014

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BackgroundFor patients hospitalised due to community-acquired pneumonia (CAP), mortality risk is usually estimated with prognostic scores such as CRB-65 or CURB-65. For elderly patients, a new score referred to as CURSI has been proposed which uses shock index (SI) instead of the blood pressure (B) and age (65) criteria. The new score has not been externally validated to date.MethodsWe used data from a hospital-based CAP registry to compare the ability of CURSI, CURB-65 and CRB-65 to predict mortality at day 30 after hospital admission. Patients were stratified by score points as well as score-point-based risk categories, and mortality for each group was assessed. To compare test performance, receiver-operating characteristic (ROC) curves were constructed, and the areas under the curve (AUROC) were calculated with 95% confidence intervals (CI).ResultsWe analysed 553 inpatients (45% females, median age 78 years) hospitalised between 2005 and 2009 for CAP. Overall, mortality at day 30 was 11% (59/553). The study sample was characterised by advanced comorbidity (chronic heart failure: 22%, chronic kidney failure: 27%) and functional impairment (nursing home residency: 26%, dementia: 31%). All risk scores were significantly associated with 30-day mortality. The AUROC values with 95% CI using score points for risk prediction were as follows: 0.63 [0.56-0.71] for CRB-65, 0.68 [0.61-0.75] for CURB-65 and 0.68 [0.61-0.75] for CURSI. The CURSI-defined low-risk group (0 or 1 score point) had a higher mortality (8%) than the low-risk groups defined by CURB-65 and CRB-65 (4% and 3%, respectively). Lowering the cut-off for the CURSI-defined low-risk group (0 point only) would lower the mortality to 4%, making it comparable to the CURB-65-defined low-risk group.ConclusionsIn our study, the CURSI-defined low-risk group had a higher 30-day mortality than the low-risk groups defined by CURB-65 and CRB-65. Lowering the cut-off value for the CURSI low-risk group would result in a mortality comparable to the CURB-65-defined low risk group. Even then, however, CURSI does not perform better than the established risk scores.

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Section: Discussionmentioning

confidence: 99%

External validation of the CURSI criteria (confusion, urea, respiratory rate and shock index) in adults hospitalised for community-acquired pneumonia

et al. 2014

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“…The current study came from two low-mortality settings. The Chinese health care system and Chinese primary care system are both so different from those in other countries [22]. A typical Chinese inpatient CAP population is that the most are young patients admitted with mild CAP.…”

Section: Discussionmentioning

confidence: 99%

Scored minor criteria for severe community-acquired pneumonia predicted better

Guo

Song

et al. 2019

Respir Res

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BackgroundInfectious Disease Society of America/American Thoracic Society (IDSA/ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality, but the major problem associated with IDSA/ATS minor criteria might be a lack of consideration of weight in prediction in clinical practice. Would awarding different points to the presences of the minor criteria improve the accuracy of the scoring system? It is warranted to explore this intriguing hypothesis.MethodsA total of 1230 CAP patients were recruited to a retrospective cohort study. This was tested against a prospective two-center cohort of 1749 adults with CAP. 2 points were assigned for the presence of PaO2/FiO2 ≤ 250 mmHg, confusion, or uremia on admission and 1 point for each of the others.ResultsThe mortality rates, and sequential organ failure assessment (SOFA) and pneumonia severity index (PSI) scores increased significantly with the numbers of IDSA/ATS minor criteria present and minor criteria scores. The correlations of the minor criteria scores with the mortality rates were higher than those of the numbers of IDSA/ATS minor criteria present. As were the correlations of the minor criteria scores with SOFA and PSI scores, compared with the numbers of IDSA/ATS minor criteria present. The pattern of sensitivity, specificity, positive predictive value, and Youden’s index of scored minor criteria of ≥2 scores or the presence of 2 or more IDSA/ATS minor criteria for prediction of mortality was the best in the retrospective cohort, and the former was better than the latter. The validation cohort confirmed a similar pattern. The area under the receiver operating characteristic curve of scored minor criteria was higher than that of IDSA/ATS minor criteria in the retrospective cohort, implying higher accuracy of scored version for predicting mortality. The validation cohort confirmed a similar paradigm.ConclusionsScored minor criteria orchestrated improvements in predicting mortality and severity in patients with CAP, and scored minor criteria of ≥2 scores or the presence of 2 or more IDSA/ATS minor criteria might be more valuable cut-off value for severe CAP, which might have implications for more accurate clinical triage decisions.

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“…We previously discovered that age ≥65 years showed independent relationship with mortality. 10 Chen et al 17 reported that the 30-day mortality rate was associated with age. Kelly et al 18 found that patients greater than 65 years of age had a higher incidence of altered mental status on presentation and that CURB scores and pneumonia severity index were higher in the older patients.…”

Section: Discussionmentioning

confidence: 99%

“…Simplified and modified minor criteria were derived in the retrospective sample by excluding 4 noncontributory or infrequent variables (leukopenia, hypothermia, hypotension, and thrombocytopenia), 3 , 4 , 7 and by excluding these variables and then adding age ≥65 years, 10 respectively (Table 1 ). The simplification and modification were tested against the prospective 2 center validation cohort.…”

Section: Methodsmentioning

confidence: 99%

Modified IDSA/ATS Minor Criteria for Severe Community-Acquired Pneumonia Best Predicted Mortality

Guo

Song

et al. 2015

Medicine

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It is not clear whether the IDSA/ATS minor criteria for severe community-acquired pneumonia (CAP) could be simplified or even be modified to orchestrate improvements in predicting mortality.A retrospective cohort study of 1230 CAP patients was performed to simplify and to modify the scoring system by excluding 4 noncontributory or infrequent variables (leukopenia, hypothermia, hypotension, and thrombocytopenia) and by excluding these variables and then adding age ≥65 years, respectively. The simplification and modification were tested against a prospective 2-center validation cohort of 1409 adults with CAP.The increasing numbers of IDSA/ATS, simplified, and modified minor criteria present in the retrospective cohort were positively associated with the mortality, showing significant increased odds ratios for mortality of 2.711, 4.095, and 3.755, respectively. The validation cohort confirmed a similar pattern. The sensitivity, specificity, positive predictive value, and Youden index of modified minor criteria for mortality prediction were the best pattern in the retrospective cohort. High values of corresponding indices were confirmed in the validation cohort. The highest accuracy of the modified version for predicting mortality in the retrospective cohort was illustrated by the highest area under the receiver operating characteristic curve of 0.925 (descending order: modified, simplified, and IDSA/ATS minor criteria). The validation cohort confirmed a similar paradigm.The IDSA/ATS minor criteria could be simplified to 5 variables and then be modified to orchestrate improvements in predicting mortality in CAP patients. The modified version best predicted mortality. These were more suitable for clinic and emergency department.

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

Cited by 6 publications

References 28 publications

External validation of the CURSI criteria (confusion, urea, respiratory rate and shock index) in adults hospitalised for community-acquired pneumonia

External validation of the CURSI criteria (confusion, urea, respiratory rate and shock index) in adults hospitalised for community-acquired pneumonia

Scored minor criteria for severe community-acquired pneumonia predicted better

Modified IDSA/ATS Minor Criteria for Severe Community-Acquired Pneumonia Best Predicted Mortality

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