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CUR-65 Score for Community-Acquired Pneumonia Predicted Mortality Better Than CURB-65 Score in Low-Mortality Rate Settings.

AbstractBACKGROUND:
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.
AuthorsHai-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
JournalThe 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
PMID26280118 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
Chemical References
  • Urea
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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