2006 Evaluation of the British Thoracic Society rules (CURB and CURB-65 severity scores*) in predicting community-acquired pneumonia with poor outcome in hospitalized patients
Dr. Sik-nga Chan, Department of Medicine, Tseung Kwan O Hospital
Study Objective
The aim of this study was to evaluate CURB and CURB-65 severity scores in predicting community acquired pneumonia (CAP) with poor outcome. Risk factors associated with 30-day mortality due to CAP were assessed.
Design
Retrospective observational study
Setting
Department of Medicine, Tseung Kwan O Hospital, Hong Kong
Patients
Adult patients admitted to hospital with CAP in 2004
Measurements and results
A total of 162 patients were included. The mean (median, range) age was 67.9 (72, 16-96) years. The overall mortality rate was 11.7%. Urea>7mmol/L, respiratory rate≥30/min, CURB score≥2 and CURB-65 score≥3 were associated with 30-day mortality, intensive care unit admission, ventilator support, prolonged length of stay, and newly need old age home arrangement. Systolic blood pressure<90mmHg increased the risk of 30-day mortality. Confusion was related to ICU admission and ventilator support while age≥65-year was associated with mortality and prolonged LOS. In multivariate analysis, respiratory rate≥28/min, systolic blood pressure<90mmHg, age≥80 years, albumin<30g/dL and multi-lobular involvement on chest radiograph were independent risk factors for 30-day mortality. Defining severe CAP as CURB severity score≥2, the 30-day mortality was 29.0%. By dividing the CURB-65 score into three risk groups (low mortality: 0-1, intermediate: 2, and high: 3-5), the mortality was 1%, 17% and 32% respectively.
Conclusion
Both CURB≥2 and CURB-65 score≥3 were associated with CAP with poor outcome in hospitalized patients. Respiratory rate≥28/min, systolic blood pressure<90mmHg, age≥80 years, albumin<30g/dL and multi-lobular involvement on chest radiograph were independent risk factors for 30-day mortality.
* CURB-65 severity score was a 6 point scoring system, ranged from 0 to 5. Features included Confusion, Urea >7 mmol/l, Respiratory rate≧30/min, low Blood pressure (diastolic blood pressure (dBP) ≦60 mm Hg or systolic blood pressure (sBP) <90 mm Hg) and age ≧ 65years. One point was given for each feature present. Same calculation for CURB severity score, but age was not included, making for a range of 0-4 points.
