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Short-term mortality of adult inpatients with community-acquired pneumonia: external validation of a modified CURB-65 score
  1. Marc Andre Pflug1,
  2. Timothy Tiutan2,
  3. Thomas Wesemann3,
  4. Harald Nüllmann3,
  5. Hans Jürgen Heppner4,
  6. Ludger Pientka3,
  7. Ulrich Thiem3,5
  1. 1School of Medicine, University of Bochum, Bochum, Germany
  2. 2College of Medicine, University of Arizona, Tucson, USA
  3. 3Department of Geriatrics, Marienhospital Herne, University of Bochum, Herne, Germany
  4. 4Department of Geriatrics, HELIOS Klinikum Schwelm, University of Witten/Herdecke, Schwelm, Germany
  5. 5Department of Medical Informatics, Biometry and Epidemiology, University of Bochum, Bochum, Germany
  1. Correspondence to Dr Ulrich Thiem, Department of Geriatrics, Marienhospital Herne, University of Bochum, Widumer Str 8, Herne D-44627, Germany; ulrich.thiem{at}rub.de

Abstract

Objective The management of community-acquired pneumonia (CAP) continues to be a challenge, especially in older people. To enable better risk stratification, a variation of the severity scores CRB-65 and CURB-65, called CURB-age, has been suggested. We compared the association between risk groups as defined by the scores and 30-day mortality for a cohort of mainly older inpatients with CAP.

Methods We retrospectively analysed data from the CAP database from the years 2005 to 2009 of a single centre in Herne, Germany. Patient characteristics, criteria values within the severity scores CURB-65, CRB-65 and CURB-age, and 30-day mortality were assessed. We compared the association between score points and score-defined risk groups and mortality. Sensitivity and specificity with corresponding 95% CIs were calculated, and receiver operating characteristic (ROC) curve analysis was performed.

Results Data from 559 patients were analysed (mean age 74.1 years, 55.3% male). Mortality at day 30 was 10.9%. CURB-age included more patients in the low-risk category than CRB-65 (195 vs 89), and the patient group had a lower mortality (2.6% vs 3.4%). When compared with CURB-65, CURB-age included slightly fewer patients (195 vs 214) with lower mortality (2.6% vs 4.2%). CURB-age sorted the most patients who died within 30 days into the high-risk CAP group (CURB-age, 32; CURB-65, 28; CRB-65, 9), which had the highest mortality (CURB-age, 26.4%; CURB-65, 19.4%; CRB-65, 21.4%). Advantages of CURB-age categories were depicted through ROC curve analysis (area under the curve 0.73 (95% CI 0.67 to 0.79) for CURB-age categories, 0.67 (95% CI 0.60 to 0.74) for CURB-65 categories, and 0.59 (95% CI 0.52 to 0.66) for CRB-65 categories).

Conclusions In comparison with CRB-65 and CURB-65, risk stratification as defined by CURB-age showed the closest association with 30-day mortality in our sample. Further prospective studies are needed to assess the potential of CURB-age for better risk prediction, especially in older patients with CAP.

  • INFECTIOUS DISEASES
  • community-acquired pneumonia
  • risk prediction
  • CURB-65
  • CURB-age

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