Validity of Pneumonia Severity Index and Curb-65 Severity Scoring Systems in Community-Acquired Pneumonia in a Third World Country

Shah, Naveed Nazir; Syed, Quibtiya K.; Shah, Bashir Ahmad; Ahmed, Waseem; Dhobi, Ghulam Nabi; Haq, Inaamul

doi:10.1016/s0012-3692(16)47639-7

Cited by 39 publications

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“…9,10,14 In present study, the mortality gradually increased as the PSI severity increases but the difference which we noticed is, our study had mortality even in PSI 1 and 2 class which was not there in Shah BA et al and this similar linear progression of mortality was not seen in CURB 65 scoring where we had maximum mortality in CURB 65 class 2 but class 3 and 4 also had significant mortality which was different from Shah BA et al which showed linear increase in mortality even with CURB 65 classes. 15 In comparison of sensitivity, specificity, NPV and PPV for different PSI classes for predicting death as an outcome we had completely opposite results when compared with results of Shah BA et al we had high specificity and low sensitivity but if we consider class ≥4 as one group and class 3 and below as another group sensitivity increases but specificity will be severely compromised and later result was statistically significant. 15 In comparison of sensitivity, specificity, NPV and PPV for different CURB 65 classes for predicting death as an outcome we had completely opposite results when compared with results of Shah BA et al and sensitivity was severely compromised to compensate this if we consider class ≥3 as one group and class 2 and below as another group sensitivity increased and it was statistically significant, dividing these groups was consistent with and also previously done in many studies like Shah BA et al and Mohanty S et al 8,15 PSI and CURB 65 scores have been extensively validated in many Indian and international studies but they never compared these scores with a newer IDSA/ATS criteria, our study has made an effort of comparing these 3 scores which showed that even though IDSA/ATS criteria did not have highest sensitivity and specificity, as a single criteria it had modest sensitivity and specificity with PPV which is better than other scoring systems in predicting both ICU admission and death making it superior to other 2 scores.…”

Section: Analysis Of Scoring Systemsmentioning

confidence: 73%

Comparative study of CURB-65, Pneumonia Severity Index and IDSA/ATS scoring systems in community acquired pneumonia in an Indian tertiary care setting

et al. 2017

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Background: Few comparative studies regarding prognostic scoring systems for community acquired pneumonia (CAP) are available from Indian context.Methods: Hospital-based prospective study to test the comparison between confusion, urea, respiratory rate, blood pressure, age over 65 years (CURB-65), Pneumonia severity index (PSI) and infectious diseases society of America/American thoracic society criteria (IDSA/ATS) scoring systems in patients with community acquired pneumonia.Results: CURB-65 class ≥III, PSI class ≥IV and patients who needed admission to intensive care unit (ICU) based on IDSA/ATS criteria were having sensitivity of 41.7%, 91.7% and 87.5% in predicting ICU admission with a specificity of 89.5%, 59.2% and 73.7% respectively. Their sensitivity in predicting death were 44.4%, 88.9% and 83.3% with a specificity of 87.8%, 54.9% and 68.3% respectively. In both PSI score and IDSA/ATS criteria risk scoring systems, mortality rate, need for ICU admission increased progressively with increasing scores but CURB-65 score did not show this correlation. The PSI class ≥IV was more sensitive in predicting ICU admission than CURB-65 and IDSA/ATS criteria.Conclusions: PSI was most sensitive in both predicting ICU admission and death whereas CURB-65 is most specific in predicting ICU admission and death. But CURB-65 is least sensitive in both predicting ICU admission and death. Even though IDSA/ATS criteria did not have highest sensitivity and specificity as single criteria it had modest sensitivity and specificity in predicting ICU admission and death.

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Section: Analysis Of Scoring Systemsmentioning

confidence: 73%

Comparative study of CURB-65, Pneumonia Severity Index and IDSA/ATS scoring systems in community acquired pneumonia in an Indian tertiary care setting

et al. 2017

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“…First, it is difficult for clinicians to evaluate changes in mental status due to pneumonia in elderly patients. 5 Second, these scoring systems can underestimate the potential severity of CAP in young patients. 32 Of the many possible laboratory biomarkers, several serum markers, such as D-dimer, 33 cortisol, 34 B-type natriuretic peptide, 35 mid-regional pro-atrial natriuretic peptide, 36 and copeptin 37 levels, correlate well with the clinical outcomes of patients with CAP.…”

Section: Discussionmentioning

confidence: 99%

“…It is often difficult to evaluate the mental status of CAP patients who are elderly or have dementia, and the severity score assigned may therefore vary among clinicians. 4,5 The quantitative serum procalcitonin level has been reported to be a useful predictive prognostic marker in CAP. [6][7][8] However, to measure quantitative procalcitonin levels, ϳ16 million yen are necessary as a capital investment before the test can be conducted in Japan.…”

Section: Introductionmentioning

confidence: 99%

Predictive Values of Semi-Quantitative Procalcitonin Test and Common Biomarkers for the Clinical Outcomes of Community-Acquired Pneumonia

Ugajin¹,

Yamaki²,

Hirasawa³

et al. 2013

Respir Care

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BACKGROUND:The semi-quantitative serum procalcitonin test (Brahms PCT-Q) is available conveniently in clinical practice. However, there are few data on the relationship between results for this semi-quantitative procalcitonin test and clinical outcomes of community-acquired pneumonia (CAP). We investigated the usefulness of this procalcitonin test for predicting the clinical outcomes of CAP in comparison with severity scoring systems and the blood urea nitrogen/serum albumin (B/A) ratio, which has been reported to be a simple but reliable prognostic indicator in our prior CAP study. METHODS: This retrospective study included data from subjects who were hospitalized for CAP from August 2010 through October 2012 and who were administered the semiquantitative serum procalcitonin test on admission. The demographic characteristics; laboratory biomarkers; microbiological test results; Pneumonia Severity Index scores; confusion, urea nitrogen, breathing frequency, blood pressure, > 65 years of age (CURB-65) scale scores; and age, dehydration, respiratory failure, orientation disturbance, pressure (A-DROP) scale scores on hospital admission were retrieved from their medical charts. The outcomes were mortality within 28 days of hospital admission and the need for intensive care. RESULTS: Of the 213 subjects with CAP who were enrolled in the study, 20 died within 28 days of hospital admission, and 32 required intensive care. Mortality did not differ significantly among subjects with different semi-quantitative serum procalcitonin levels; however, subjects with serum procalcitonin levels > 10.0 ng/mL were more likely to require intensive care than those with lower levels (P < .001). The elevation of semi-quantitative serum procalcitonin levels was more frequently observed in subjects with proven etiology, especially pneumococcal pneumonia. Using the receiver operating characteristic curves for mortality, the area under the curve was 0.86 for Pneumonia Severity Index class, 0.81 for B/A ratio, 0.81 for A-DROP, 0.80 for CURB-65, and 0.57 for semi-quantitative procalcitonin test. CONCLU-SIONS: The semi-quantitative serum procalcitonin level on hospital admission was less predictive of mortality from CAP compared with the B/A ratio. However, the subjects with serum procalcitonin levels > 10.0 ng/mL were more likely to require intensive care than those with lower levels.

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“…However, PSI was more sensitive in predicting ICU admission than CURB-65, which is also not harmonized with our findings. [3] There are also some other studies regarding the involvement of biomarkers, other scoring systems and their validity for the severity in CAP. They had, in some manner similar and in other ways dissimilar findings.…”

Section: Discussionmentioning

confidence: 99%

“…[2] CURB-65 (confusion, urea nitrogen, respiratory rate, blood pressure, ≥ 65 years) and Pneumonia Severity Index (PSI) are the most oftentimes used scoring scales to assess the disease severity. [3] These scoring tools are useful to clinch between hospitalization and outpatient treatment with an oral antibiotic. The inflammatory reaction [4][5][6] was reported as a primary reason for hypoalbuminemia.…”

Section: Introductionmentioning

confidence: 99%

Study on the utilities of the role of biomarkers like albumin, CRP, PCT and blood urea nitrogen to serum albumin (B/A) ratio in the prediction of development of complications, prognosis, and need of ICU during the course of CAP

Patel¹,

Makadia²,

Patel³

et al. 2016

Int J of Biomed & Adv Res

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Context: Community-acquired pneumonia (CAP) is a serious illness. Early studies of community-acquired pneumonia reported that nonsurvivors had higher blood urea nitrogen levels and lower serum albumin levels than survivors. Therefore, elevation of the blood urea nitrogen to serum albumin (B/A) ratio may classify patients with community-acquired pneumonia who are becoming critically ill. Aim: To study the role of biomarkers in the prediction of development of complications, prognosis and need of ICU during the course of community-acquired pneumonia (CAP). Settings and Design: This is a retrospective study. Material and Method: The present study was conducted in the department of Biochemistry. 200 patient's data, required for the study was collected from the online LIS system, Chest-Medicine ward and medical ICU department. Statistical Analysis Used: Statistical analysis was performed by Pearson's correlation coefficient (r) and ROC plots. Results: B/A, PCT, and CRP are statistically significantly positively correlated with the severity of the CAP, decided on the base of PSI and CURB-65 scoring system. (Correlation coefficient r=0.7368, 0.6412 and 0.8064 respectively. P<0.0001). These biomarkers also have good sensitivity and specificity for deciding need of the ICU during the course of CAP. Conclusions: In our present study, we found an expressive and unaided positive correlation between B/A (BUN-Blood urea nitrogen/Albumin) ratio and severity of CAP. Both serum biochemical markers, blood urea nitrogen and albumin, are commonly used and can be measured promptly. Thus, our study suggests that the B/A ratio on admission can be a rapid, simple, cost-effective and predictable prognostic and severity indicator for CAP.

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Validity of Pneumonia Severity Index and Curb-65 Severity Scoring Systems in Community-Acquired Pneumonia in a Third World Country

Cited by 39 publications

References 0 publications

Comparative study of CURB-65, Pneumonia Severity Index and IDSA/ATS scoring systems in community acquired pneumonia in an Indian tertiary care setting

Comparative study of CURB-65, Pneumonia Severity Index and IDSA/ATS scoring systems in community acquired pneumonia in an Indian tertiary care setting

Predictive Values of Semi-Quantitative Procalcitonin Test and Common Biomarkers for the Clinical Outcomes of Community-Acquired Pneumonia

Study on the utilities of the role of biomarkers like albumin, CRP, PCT and blood urea nitrogen to serum albumin (B/A) ratio in the prediction of development of complications, prognosis, and need of ICU during the course of CAP

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