Disposition and recommendation: severe pneumonia; consider admitting in ICU and treated with intensive care. CURB score: 4 to 5 Mortality percentage: The main use of the CURB score is to predict the action needed to be taken for a patient with pneumonia. There is another term that is used to check the mortality of a patient; which is the pneumonia severity index PSI. Both are often compared but PSI is, however, more precise for short-term mortality with higher discriminative power as compared with the CURB and its predecessors. On the other hand, PSI is complicated and require more information and tests like arterial blood gas sampling and other tests and as compared CURB is more easy to use for primary care settings.
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See Sci Rep. This article has been cited by other articles in PMC. Abstract Aim of this study was to develop a new simpler and more effective severity score for community-acquired pneumonia CAP patients. The effectiveness of different pneumonia severity scores to predict mortality was compared, and the performance of the new score was validated on an external cohort of patients with pneumonia admitted to a teaching hospital in Italy.
The day mortality and length of stay were increased along with increased risk score. The AUCs in the prediction of day mortality in the main cohort were 0. The performance of this bedside score was confirmed in CAP patients of the validation cohort although calibration was not successful in patients with health care-associated pneumonia HCAP. The expanded CURB is objective, simpler and more accurate scoring system for evaluation of CAP severity, and the predictive efficiency was better than other score systems.
Community-acquired pneumonia CAP is one of the most common infectious diseases needing hospitalization. Inappropriate treatment of outpatient or delay of admission of CAP patients to ICU has been shown to be associated with increased mortality 1 , 2 , and it is important for physicians to identify patients who are experiencing severe pneumonia with probably worst prognosis as early as possible.
Moreover, pneumonia occurring in patients living in the community but with a recent exposure to the healthcare system i. Several studies suggest that this category of pneumonia has a higher mortality than CAP 3 , 4. Multiple serum biomarkers and several established risk scores have been used to assess the severity of CAP to improve management of CAP patients. CAP patients can be assigned into 5 risk classes. Patients with class IV—V should be hospitalized for treatment as the prognosis deteriorates along with increasing risk class.
Although the PSI exhibits a high discriminatory power for assigning appropriate risk class, it is complicated to calculate and limits clinical application. CURB simplifies the scoring system compared with PSI, but at the expense of reducing sensitivity for the day mortality.
For instance, many young patients were incorrectly categorized as low risk. It is still complicated to calculate multiple points for different variables and age-adjusted cut-off 7 , and a further score A-DROP: Age, Dehydration, Respiratory failure, Orientation disturbance, Systolic blood pressure was developed in Japan 8. All of the scores can help determine whether a patient needs to be hospitalized or even admitted to the ICU 9. Clearly, a simpler, but more reliable score system is needed.
In this study, we evaluated multiple risk factors contributing to the day mortality in hospitalized pneumonia patients coming from the community. Then we developed a simpler and more effective scoring system by expanding CURB, to evaluate its efficiency compared to currently available scores for severity assessment.
Patients were excluded if they had HIV infection or if had been in hospital within the previous 7 days 3. Comorbidities were documented, defined as presence of one or more of the following diseases: congestive heart failure, chronic obstructive pulmonary diseases COPD , chronic renal diseases, chronic liver diseases, cerebrovascular diseases, malignancy solid tumor or hematological malignancy , or diabetes mellitus The Ethics Committee of the involved hospitals approved this study.
The laboratory findings were analyzed within 24 h after admission. External validation The new score obtained was validated on an external prospective cohort of adult patients with pneumonia hospitalized in a bed teaching hospital Policlinico Umberto I-Rome from Italy. Study methods were previously reported 13 , Briefly, we prospectively collected data of all episodes of pneumonia during the period between January and March All patients were followed-up to discharge or death. Correlations between two continuous variables were assessed with the Pearson correlation.
Distribution of the analyzed continuous variables for normality was tested with the Kolmogorov-Smirnov test. Multiple logistic regression analysis was used to determine independent risk factors for mortality. We evaluated discrimination using receiver operating characteristic curves ROC and compared the areas under the ROC curves AUCs for the different scores, adjusting the probability using the Sidak method.
Computations were carried out with SPSS Results Patient characteristics A total of hospitalized patients with CAP were evaluated in this retrospective study, and of them were finally eligible for analysis. The general characteristics of these patients are shown in Table 1.
Overall, Table 1 Baseline characteristics of CAP patients. Demographic data.
CURB-65 Score for Pneumonia Severity
This health calculator provides a useful tool for all clinicians interested to risk stratify patients with community acquired pneumonia based on five clinical determinations and an interpretation comprising of a 30 days mortality risk prediction. The CURB is a model that has been adapted after a research by Lim, a study that took place in the UK, the Netherlands and New Zealand that aimed to validate the previous Pneumonia Severity Index PSI and discover whether there are other connections between mortality and clinical determinations. Although the above factors are very straight forward and can easily be interpreted to provide the overall score, every study that cites the original one states that clinical decision making should still be above all scoring, regardless of the risk stratification model used. CURB interpretation As a clinical prediction rule, this model has been validated in several setting and is also recommended by the British Thoracic Society in the severity assessment of acute pneumonia cases.
Escala CURB-65 para Neumonía adquirida en la Comunidad