CURB-65 score predicted mortality in community-acquired pneumonia better than IDSA/ATS minor criteria in a low-mortality-rate setting

  • Q. Guo
  • H.-Y. Li
  • Y.-P. Zhou
  • M. Li
  • X.-K. Chen
  • H. Liu
  • H.-L. Peng
  • H.-Q. Yu
  • X. Chen
  • N. Liu
  • L.-H. Liang
  • Q.-Z. Zhao
  • M. Jiang
Article

Abstract

The CURB-65 scoring system performs well at identifying patients with pneumonia who have a low risk of death. Whether it predicts mortality in community-acquired pneumonia (CAP) better than the 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) minor criteria in low-mortality-rate settings is not clear. The purpose of this study was to determine the hypothesis.A total of 1,230 adult inpatients admitted to our hospital from 2005 to 2009 for CAP were reviewed retrospectively.The hospital mortality was 1.3 %. Percentage mortality increased significantly with CURB-65 score and the increasing number of IDSA/ATS minor criteria present. The number of CURB-65 criteria or IDSA/ATS minor criteria present had significant increased odds ratios for mortality of 7.547 and 2.711, respectively. The sensitivities of a CURB-65 score of ≥3 and the presence of ≥3 minor criteria in predicting mortality was 25 % and 37.5 %, which increased to 75 % and 62.5 %, while the cut-off values reduced to ≥2 criteria, respectively. The area under the receiver operating characteristic curve for CURB-65 was greater than the corresponding area for IDSA/ATS minor criteria in predicting hospital mortality (0.915 vs. 0.805, p = 0.0091).CURB-65 score predicted hospital mortality better than IDSA/ATS minor criteria, and a CURB-65 score of ≥2 or the presence of ≥2 minor criteria might be more valuable cut-off values for “severe” CAP in a low-mortality-rate setting.

Notes

Acknowledgments

We are indebted to the nurses, further education physicians, and postgraduates of the Department of Respiratory Medicine, and the staff of the Department of Medical Record for making contributions to this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Financial support

The study was funded by the medical science and technology foundation of Guangdong province in 2010 (No. A2010553), the planned science and technology project of Shenzhen municipality in 2011 (No. 201102078), and the non-profit scientific research project of Futian district in 2011 (No. FTWS201120).

Authors’ contributions

Q.G, H-Y.L, and Y-P.Z made substantial contributions to conception and design. Q.G and H-Y.L were in charge of data collection and wrote the manuscript. L-H.L, Q-Z.Z, Y-P.Z, and M.L read the chest radiographs and CT scans. X-K.C, H.L, H-L.P, H-Q.Y, X.C, and N.L made substantial contributions to acquisition of data. M.J was in charge of statistical analysis.

References

  1. 1.
    Mandell LA, Wunderink RG, Anzueto A et al (2007) Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44(Suppl 2):S27–S72PubMedCrossRefGoogle Scholar
  2. 2.
    Guo Q, Li YM, Nong LB et al (2009) Evaluation of compliance with bundle treatment in the management of severe infection. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 21:8–12PubMedGoogle Scholar
  3. 3.
    Restrepo MI, Anzueto A (2009) Severe community-acquired pneumonia. Infect Dis Clin North Am 23:503–520PubMedCrossRefGoogle Scholar
  4. 4.
    British Thoracic Society Standards of Care Committee (2001) BTS guidelines for the management of community acquired pneumonia in adults. Thorax 56(Suppl 4):IV1–IV64Google Scholar
  5. 5.
    Lim WS, Baudouin SV, George RC et al (2009) BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 64(Suppl 3):iii1–iii55PubMedCrossRefGoogle Scholar
  6. 6.
    Guo Q, Li HY, Zhou YP et al (2011) Weight of the IDSA/ATS minor criteria for severe community-acquired pneumonia. Respir Med 105:1543–1549PubMedCrossRefGoogle Scholar
  7. 7.
    Liapikou A, Ferrer M, Polverino E et al (2009) Severe community-acquired pneumonia: validation of the Infectious Diseases Society of America/American Thoracic Society guidelines to predict an intensive care unit admission. Clin Infect Dis 48:377–385PubMedCrossRefGoogle Scholar
  8. 8.
    Loke YK, Kwok CS, Niruban A et al (2010) Value of severity scales in predicting mortality from community-acquired pneumonia: systematic review and meta-analysis. Thorax 65:884–890PubMedCrossRefGoogle Scholar
  9. 9.
    Falcone M, Corrao S, Venditti M et al (2011) Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia. Intern Emerg Med 6:431–436PubMedCrossRefGoogle Scholar
  10. 10.
    Jones BE, Jones J, Bewick T et al (2011) CURB-65 pneumonia severity assessment adapted for electronic decision support. Chest 140:156–163PubMedCrossRefGoogle Scholar
  11. 11.
    Phua J, See KC, Chan YH et al (2009) Validation and clinical implications of the IDSA/ATS minor criteria for severe community-acquired pneumonia. Thorax 64:598–603PubMedCrossRefGoogle Scholar
  12. 12.
    Hilbert G, Gruson D, Vargas F et al (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487PubMedCrossRefGoogle Scholar
  13. 13.
    Niederman MS, Mandell LA, Anzueto A et al (2001) Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 163:1730–1754PubMedGoogle Scholar
  14. 14.
    Dellinger RP, Carlet JM, Masur H et al (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32:858–873PubMedCrossRefGoogle Scholar
  15. 15.
    Aujesky D, Auble TE, Yealy DM et al (2005) Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med 118:384–392PubMedCrossRefGoogle Scholar
  16. 16.
    Brown SM, Jones BE, Jephson AR et al (2009) Validation of the Infectious Disease Society of America/American Thoracic Society 2007 guidelines for severe community-acquired pneumonia. Crit Care Med 37:3010–3016PubMedCrossRefGoogle Scholar
  17. 17.
    Schuetz P, Koller M, Christ-Crain M et al (2008) Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings. Epidemiol Infect 136:1628–1637PubMedCrossRefGoogle Scholar
  18. 18.
    Lim WS, van der Eerden MM, Laing R et al (2003) Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58:377–382PubMedCrossRefGoogle Scholar
  19. 19.
    Niederman MS, McCombs JS, Unger AN et al (1998) The cost of treating community-acquired pneumonia. Clin Ther 20:820–837PubMedCrossRefGoogle Scholar
  20. 20.
    Colice GL, Morley MA, Asche C et al (2004) Treatment costs of community-acquired pneumonia in an employed population. Chest 125:2140–2145PubMedCrossRefGoogle Scholar
  21. 21.
    Bartolomé M, Almirall J, Morera J et al (2004) A population-based study of the costs of care for community-acquired pneumonia. Eur Respir J 23:610–616PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Q. Guo
    • 1
  • H.-Y. Li
    • 2
  • Y.-P. Zhou
    • 1
  • M. Li
    • 1
  • X.-K. Chen
    • 1
  • H. Liu
    • 1
  • H.-L. Peng
    • 1
  • H.-Q. Yu
    • 1
  • X. Chen
    • 1
  • N. Liu
    • 1
  • L.-H. Liang
    • 3
  • Q.-Z. Zhao
    • 3
  • M. Jiang
    • 4
  1. 1.Department of Respiratory Medicine, Affiliated Futian HospitalGuangdong Medical CollegeShenzhenChina
  2. 2.Department of Primary Care, Affiliated Futian HospitalGuangdong Medical CollegeShenzhenChina
  3. 3.Department of Radiology, Affiliated Futian HospitalGuangdong Medical CollegeShenzhenChina
  4. 4.Guangzhou Institute of Respiratory Diseases (State Key Laboratory of Respiratory Diseases), First Affiliated HospitalGuangzhou Medical UniversityGuangzhouChina

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