Usefulness of CURB-65 and Pneumonia Severity Index for Influenza A H1N1v pneumonia

Estella, Ángel

doi:10.4081/monaldi.2012.144

Cited by 13 publications

(25 citation statements)

References 10 publications

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“…Though it has been previously demonstrated that PSI ≥ class IV indicates increased disease severity and is strongly associated with ICU admission [28,29], our results show that PSI scores cannot be used to accurately prognosticate viral CAPs. Furthermore, literature suggests that PSI often underestimates the risk of patients with Influenza A H1N1 pneumonia [30,31] and neither PSI nor CURB-65 scores can be used to predict ICU admission or need for mechanical ventilation in influenza patients31. The CDC recommends early antiviral therapy for patients who are suspected of suffering from influenza [32].…”

Section: Discussionmentioning

confidence: 99%

Severity of disease and mortality for hospitalized patients with community-acquired viral pneumonia compared to patients with community-acquired bacterial pneumonia

Kim¹,

Chandler²,

Furmanek³

et al. 2019

JRI

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Background: There exists a large body of literature to help identify, diagnose, treat, and manage community-acquired pneumonia (CAP). Despite this, there is little data that directly compares the clinical syndromes and complications of pure bacterial pneumonia to pure viral pneumonia. Our study compares the clinical presentation, morbidity and mortality of viral vs. bacterial etiologies of CAP. Methods: This was a secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) international study database. Data was collected concerning patient demographics, physical examination findings, laboratory findings, radiological findings, severity of illness, and clinical outcomes and stratified according to the two study groups, CAVP and CABP. A microbiological diagnosis of CABP was based on the isolation of a bacterium from a respiratory sample, blood culture and/or identification of a urinary antigen for Streptococcus or Legionella; microbiological diagnosis of CAVP was based on polymerase chain reaction or antigen detection from respiratory samples. Results: Our study included 1,913 patients. Of these, 286 (15.0%) had viral infection, while 1,627 (85.0%) had CAVP. We found that bacterial CAP patients are older, more frequently male, and suffer from a higher proportion of comorbidities when compared to viral CAP patients. Comparison of physical exam findings and laboratory values failed to find a clinically significant difference between bacterial and viral CAP patients. When comparing severity of illness, bacterial CAP patients had greater frequency of PSI ≥ class IV; however, viral CAP patients more frequently needed ICU admission, ventilator support, vasopressor support, and had higher rate of in hospital mortality. Conclusions: Our study confirms the extreme difficulty differentiating CABP from CAVP using demographics, physical exam, or x-ray findings. We found no major clinical or laboratory findings distinguishing CABP from CAVP. The increased severity of illness of CAVP compared to bacterial etiologies shows that PSI scores may not be an accurate indicator of severity of disease. More studies are needed to identify the best process of care for patients with CAP, including the potential benefits of routine respiratory viral panel testing and empiric antiviral therapy.

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Section: Discussionmentioning

confidence: 99%

Severity of disease and mortality for hospitalized patients with community-acquired viral pneumonia compared to patients with community-acquired bacterial pneumonia

Kim¹,

Chandler²,

Furmanek³

et al. 2019

JRI

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“…Commons and Denholm investigated 105 patients of H1N1 influenza infection and found that the common used CAP severity scores (PSI and CURB‐65) had insufficient predictive ability to low‐risk patients in ICU admission. Other researches also showed that routine prediction rules underestimated severity of influenza A 2009 (H1N1) Pneumonia, but no effective severity score had been put forward. In our study, PSI and CURB‐65 underestimated a significant number of hospitalized patients.…”

Section: Discussionmentioning

confidence: 99%

Mortality prediction to hospitalized patients with influenza pneumonia: PO₂/FiO₂ combined lymphocyte count is the answer

Shi

et al. 2015

Clinical Respiratory J

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Introduction Community‐acquired pneumonia (CAP) severity scores perform well in predicting mortality of CAP patients, but their applicability in influenza pneumonia is powerless. Objectives The aim of our research was to test the efficiency of PO2/FiO2 and CAP severity scores in predicting mortality and intensive care unit (ICU) admission with influenza pneumonia patients. Methods We reviewed all patients with positive influenza virus RNA detection in Beijing Chao‐Yang Hospital during the 2009–2014 influenza seasons. Outpatients, inpatients with no pneumonia and incomplete data were excluded. We used receiver operating characteristic curves (ROCs) to verify the accuracy of severity scores or indices as mortality predictors in the study patients. Results Among 170 hospitalized patients with influenza pneumonia, 30 (17.6%) died. Among those who were classified as low‐risk (predicted mortality 0.1%–2.1%) by pneumonia severity index (PSI) or confusion, urea, respiratory rate, blood pressure, age ≥65 year (CURB‐65), the actual mortality ranged from 5.9 to 22.1%. Multivariate logistic regression indicated that hypoxia (PO2/FiO2 ≤ 250) and lymphopenia (peripheral blood lymphocyte count <0.8 × 109/L) were independent risk factors for mortality, with OR value of 22.483 (95% confidence interval 4.927–102.598) and 5.853 (95% confidence interval 1.887–18.152), respectively. PO2/FiO2 combined lymphocyte count performed well for mortality prediction with area under the curve (AUC) of 0.945, which was significantly better than current CAP severity scores of PSI, CURB‐65 and confusion, respiratory rate, blood pressure, age ≥65 years for mortality prediction (P < 0.001). The scores or indices for ICU admission prediction to hospitalized patients with influenza pneumonia confirmed a similar pattern and PO2/FiO2 combined lymphocyte count was also the best predictor for predicting ICU admission. Conclusion In conclusion, we found that PO2/FiO2 combined lymphocyte count is simple and reliable predictor of hospitalized patients with influenza pneumonia in predicting mortality and ICU admission. When PO2/FiO2 ≤ 250 or peripheral blood lymphocyte count <0.8 × 109/L, the clinician should pay great attention to the possibility of severe influenza pneumonia.

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“…Several previous studies have reported the use of different prognostic scales of pneumonia to evaluate influenza [39][40][41][42][43][44]. Myles et al [39] compared the performance of Community Assessment Tools (CATs), CURB-65 score, and the Pandemic Medical Early Warning Score in influenza.…”

Section: Discussionmentioning

confidence: 99%

“…However, theirs was a case-control study and was limited to H1N1 infections, which might have conferred some bias. Another retrospective study used eight different scoring tools, including CURB-65, Mortality in Emergency Department Sepsis (MEDS) score, the Nursing Home-Acquired Pneumonia score, PMEWS, Pneumonia Severity Index, severity score for the elderly with community-acquired pneumonia score, SMART-COP Score, and Simple Triage Scoring System, to predict the outcomes of influenza in the ED [40,43]. These researchers found that the PSI and MEDS scores were moderately predictive of inhospital mortality, and the SMARTCOP score was a good predictor of ICU admission.…”

Section: Discussionmentioning

confidence: 99%

Prognostic accuracy of SIRS criteria and qSOFA score for in-hospital mortality among influenza patients in the emergency department

Chu

Seak

et al. 2020

BMC Infect Dis

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Background: The seasonal influenza epidemic is an important public health issue worldwide. Early predictive identification of patients with potentially worse outcome is important in the emergency department (ED). Similarly as with bacterial infection, influenza can cause sepsis. This study was conducted to investigate the effectiveness of the Systemic Inflammatory Response Syndrome (SIRS) criteria and the quick Sequential Organ Failure Assessment (qSOFA) score as prognostic predictors for ED patients with influenza. Methods: This single-center, retrospective cohort study investigated data that was retrieved from a hospital-based research database. Adult ED patients (age ≥ 18 at admission) with laboratory-proven influenza from 2010 to 2016 were included for data analysis. The initial SIRS and qSOFA scores were both collected. The primary outcome was the utility of each score in the prediction of in-hospital mortality. Results: For the study period, 3561 patients met the study inclusion criteria. The overall in-hospital mortality was 2.7% (95 patients). When the qSOFA scores were 0, 1, 2, and 3, the percentages of in-hospital mortality were 0.6, 7.2, 15.9, and 25%, respectively. Accordingly, the odds ratios (ORs) were 7.72, 11.92, and 22.46, respectively. The sensitivity and specificity was 24 and 96.2%, respectively, when the qSOFA score was ≥2. However, the SIRS criteria showed no significant associations with the primary outcome. The area under the receiver operating characteristic curve (AUC) was 0.864, which is significantly higher than that with SIRS, where the AUC was 0.786 (P < 0.01). Conclusions: The qSOFA score potentially is a useful prognostic predictor for influenza and could be applied in the ED as a risk stratification tool. However, qSOFA may not be a good screening tool for triage because of its poor sensitivity. The SIRS criteria showed poor predictive performance in influenza for mortality as an outcome. Further research is needed to determine the role of these predictive tools in influenza and in other viral infections.

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Usefulness of CURB-65 and Pneumonia Severity Index for Influenza A H1N1v pneumonia

Abstract: Use of CURB-65 and PSI in the emergency department may underestimate the risk of patients with Influenza A H1N1v pneumonia. Based in our results, the ability of these scales to predict ICU admissions for Influenza A H1N1v pneumonia is questioned.

Cited by 13 publications

References 10 publications

Severity of disease and mortality for hospitalized patients with community-acquired viral pneumonia compared to patients with community-acquired bacterial pneumonia

Severity of disease and mortality for hospitalized patients with community-acquired viral pneumonia compared to patients with community-acquired bacterial pneumonia

Mortality prediction to hospitalized patients with influenza pneumonia: PO₂/FiO₂ combined lymphocyte count is the answer

Prognostic accuracy of SIRS criteria and qSOFA score for in-hospital mortality among influenza patients in the emergency department

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Usefulness of CURB-65 and Pneumonia Severity Index for Influenza A H1N1v pneumonia

Abstract: Use of CURB-65 and PSI in the emergency department may underestimate the risk of patients with Influenza A H1N1v pneumonia. Based in our results, the ability of these scales to predict ICU admissions for Influenza A H1N1v pneumonia is questioned.

Cited by 13 publications

References 10 publications

Severity of disease and mortality for hospitalized patients with community-acquired viral pneumonia compared to patients with community-acquired bacterial pneumonia

Severity of disease and mortality for hospitalized patients with community-acquired viral pneumonia compared to patients with community-acquired bacterial pneumonia

Mortality prediction to hospitalized patients with influenza pneumonia: PO2/FiO2 combined lymphocyte count is the answer

Prognostic accuracy of SIRS criteria and qSOFA score for in-hospital mortality among influenza patients in the emergency department

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Mortality prediction to hospitalized patients with influenza pneumonia: PO₂/FiO₂ combined lymphocyte count is the answer