Comparative Effectiveness of CURB-65 and qSOFA Scores in Predicting Pneumonia Outcomes: A Systematic Review

Abstract

Pneumonia is a leading cause of hospitalization and mortality worldwide, often progressing to sepsis, making early accurate severity assessment crucial for effective clinical decision-making. This systematic review compares the CURB-65 (confusion, urea, respiratory rate, blood pressure, and age ≥65 years) and qSOFA scoring systems in predicting pneumonia outcomes, including short-term mortality and ICU admission, to provide evidence-based recommendations for their clinical application. A comprehensive search was conducted across multiple databases, including PubMed, Medline, Web of Science, Google Scholar, Cochrane Library, and BMJ Journals, using specific keywords related to pneumonia and the scoring systems. Eligible studies included adult patients diagnosed with community-acquired, hospital-acquired, or healthcare-associated pneumonia (HAP), where CURB-65 or qSOFA scores were calculated within 24 hours of admission. Data extraction focused on study characteristics, patient demographics, and outcome measures, with quantitative synthesis comparing the predictive performance of the two scores. Sensitivity, specificity, and area under the ROC curve (AUC) values were assessed, and potential sources of heterogeneity and publication bias were examined. The analysis included 22 studies with a total of 25,846 participants, revealing varying predictive accuracy across different settings. CURB-65 demonstrated superior sensitivity (76.52%) and AUC (0.747) for mortality prediction, making it a more reliable tool for identifying high-risk pneumonia patients who require intensive management. Conversely, qSOFA exhibited superior specificity (86.08%) and better performance in predicting ICU admissions, with an AUC of 0.714, highlighting its utility in identifying patients who may need critical care interventions. This systematic review underscores the strengths and limitations of both CURB-65 and qSOFA in predicting pneumonia outcomes. While CURB-65 is more effective for mortality prediction, qSOFA excels in predicting ICU admissions. A combined approach leveraging both scoring systems could enhance patient assessment and management. Further research with larger, prospective studies is recommended to validate these findings and optimize the clinical use of CURB-65 and qSOFA in pneumonia management.