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.
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Authors | Hai-yan Li, Qi Guo, Wei-dong Song, Yi-ping Zhou, Ming Li, Xiao-ke Chen, Hui Liu, Hong-lin Peng, Hai-qiong Yu, Xia Chen, Nian Liu, Zhong-dong Lü, Li-hua Liang, Qing-zhou Zhao, Mei Jiang |
Journal | The American journal of the medical sciences
(Am J Med Sci)
Vol. 350
Issue 3
Pg. 186-90
(Sep 2015)
ISSN: 1538-2990 [Electronic] United States |
PMID | 26280118
(Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- Cohort Studies
- Community-Acquired Infections
(diagnosis, mortality)
- Confusion
(diagnosis, epidemiology)
- Female
- Hospital Mortality
(trends)
- Humans
- Hypotension
(diagnosis, epidemiology)
- Male
- Middle Aged
- Pneumonia, Bacterial
(diagnosis, mortality)
- Predictive Value of Tests
- Prognosis
- Prospective Studies
- ROC Curve
- Respiratory Rate
- Retrospective Studies
- Sensitivity and Specificity
- Severity of Illness Index
- Urea
(blood)
- Uremia
(diagnosis, epidemiology)
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