Comparative Study of Pneumonia Severity Index and Curb65 in Assesing the Severity of Community Acquired Pneumonia

Abstract

Pneumonia is one of the leading causes of death and morbidity, both in developing and developed countries and is the commonest cause of hospitalization in adults and children. In the assessment and management of Community Acquired Pneumonia [CAP], disease assessment is crucial, guiding therapeutic options. Knowledge of relevant prognostic factors might be useful for early identification of patients at high risk requiring intensive care treatment. AIMS AND OBJECTIVES: To study and compare Pneumonia Severity Index and CURB-65 in assessing the severity of Community Acquired Pneumonia. MATERIALS AND METHODS: 60 cases of Community Acquired Pneumonia admitted in the Department of General Medicine, Victoria hospital and Bowring and Lady Curzon hospital, BMCRI, Bangalore between the periods of October 2010 to September 2012 were included in the study. All the patients are assessed using Pneumonia Severity Index scoring and CURB65 scoring. STATISTICAL METHODS: Analysis of variance (ANOVA) has been used to find the significance of study parameters between three or more groups of patients, Chi-square/ Fisher Exact test has been used to find the significance of study parameters on categorical scale between two or more groups. RESULTS AND CONCLUSIONS: The comparison between mortality rates in different risk classes in our study and that of the previous studies showed that in all the studies mortality rates progressively increases with increasing risk scores in both PSI and CURB-65 risk classes. The comparison of PSI and CURB-65 with respect to sensitivity, specificity and predictive values has good specificity and NPV but sensitivity and PPV are less impressive. Specificity of CURB-65 was found to be better than PSI probably because a major limitation of the PSI is the unbalanced impact of age on the score, resulting in a potential underestimation of severe CAP particularly in younger otherwise healthy individuals. In predicting ICU admission, both PSI and CURB65 has good specificity and in predicting ventilation, PSI has better sensitivity than CURB65. By using the knowledge of these criteria, patients of CAP can be better prognosticated as regards severity of their illness with consequently better triaging of patients, utilisation of resources and appropriate treatment to improve the outcome in this disease