CUR-65 Score for Community-Acquired Pneumonia Predicted Mortality Better Than CURB-65 Score in Low–Mortality Rate Settings. (September 2015)

• Record Type: Journal Article
• Authors: Li, Hai-yan; Guo, Qi; Song, Wei-dong; Zhou, Yi-ping; Li, Ming; Chen, Xiao-ke; Liu, Hui; Peng, Hong-lin; Yu, Hai-qiong; Chen, Xia; Liu, Nian; Lü, Zhong-dong; Liang, Li-hua; Zhao, Qing-zhou; Jiang, Mei
• Is Part Of: American journal of the medical sciences. Volume 350:Number 3(2015)
• Publication Date: 2015-09
• Subjects: Community-acquired pneumonia -- CUR-65 -- CURB-65 -- Mortality -- Prognosis; Medicine -- Periodicals; Internal medicine -- Periodicals; 610.5
• DOI: 10.1097/MAJ.0000000000000545
• Languages: English
• ISSNs: 0002-9629

Abstract

Abstract: Background: It is not clear whether low-blood pressure criterion could be removed from CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30/min, low blood pressure and age ≥65 years) score to orchestrate an improvement in identifying patients with community-acquired pneumonia (CAP) in low–mortality rate settings. Methods: A retrospective cohort study of 1, 230 CAP patients was performed to simplify the CURB-65 scoring system by excluding low-blood pressure variable. The simplification was validated in a prospective 2-center cohort of 1, 409 adults with CAP. Results: The hospital mortalities were 1.3% and 3.8% in the retrospective and prospective cohorts, respectively. The mortality rates in the 2 cohorts increased directly with the increasing scores, showing significant increased odds ratios for mortality. The pattern of sensitivity, specificity, positive predictive value and Youden's index of a CUR-65 (Confusion, Urea >7 mmol/L, Respiratory rate ≥30/min and age ≥65 years) score of ≥2 for prediction of mortality was better than that of a CURB-65 score of ≥3 in the retrospective cohort. Higher values of corresponding indices were confirmed in the validation cohort. The higher accuracy of CUR-65 score for predicting mortality was illustrated by the area under the receiver operating characteristic curve of 0.937, compared with 0.915 for CURB-65 score in the retrospective cohort ( P = 0.0073). The validation cohort confirmed a similar paradigm (0.953 versus 0.907, P = 0.0002). Conclusions: CURB-65 score could be simplified by removing low blood pressure to orchestrate an improvement in predicting mortality in CAP patients who have a low risk of death. A CUR-65 score of ≥2 might be a more valuable cutoff value for severe CAP.