Value of severity scales in predicting mortality from community-acquired pneumonia: systematic review and meta-analysis

Abstract

Background Several scoring systems have been used to predict mortality in patients with community-acquired pneumonia. The properties of commonly used risk stratification scales were systematically reviewed. Methods MEDLINE and EMBASE (January 1999eOctober 2009) were searched for prospective studies that reported mortality at 4e8 weeks in patients with radiographically-confirmed community-acquired pneumonia. The search focused on the Pneumonia Severity Index (PSI) and the three main iterations of the CURB (confusion, urea nitrogen, respiratory rate, blood pressure) scale (CURB-65, CURB, CRB-65), and test performance was evaluated based on 'higher risk' categories as follows: PSI class IV/V, CURB-65 (score $3), CURB (score $2) and CRB-65 (score $2). Random effects meta-analysis was used to generate summary statistics of test performance and receiver operating characteristic curves were used for predicting mortality. Results 402 articles were screened and 23 studies involving 22 753 participants (average mortality 7.4%) were retrieved. The respective diagnostic odds ratios for mortality were 10.77 (PSI), 6.40 (CURB-65), 5.97 (CRB-65) and 5.75 (CURB). Overall, PSI had the highest sensitivity and lowest specificity for mortality, CRB-65 was the most specific (but least sensitive) test and CURB-65/ CURB were between the two. Negative predictive values for mortality were similar among the tests, ranging from 0.94 (CRB-65) to 0.98 (PSI), whereas positive predictive values ranged from 0.14 (PSI) to 0.28 (CRB-65). Conclusions The current risk stratification scales (PSI, CURB-65, CRB-65 and CURB) have different strengths and weaknesses. All four scales had good negative predictive values for mortality in populations with a low prevalence of death but were less useful with regard to positive predictive values. BACKGROUND

Factors associated with hospital mortality in community-acquired legionellosis in France

“…Acute Physiology and Chronic Health Evaluation II score .15 at admission and serum sodium levels f136 mEq?L -1 were the only independent factors related to death [22]. blood pressure ,90 mmHg or diastolic blood pressure f60 mmHg, and age o65 yrs), CRB-65 (confusion, respiratory frequency o30 breaths?min -1 , systolic blood pressure ,90 mmHg or diastolic blood pressure f60 mmHg, and age o65 yrs), and observed that higher risk patients were better identified with CURB-65 and CRB-65 scores, whereas PSI better distinguished lower-risk patients [23,24]. Unfortunately, our study was not designed to compare SOI scores, and because some variables included in these scores were not collected, any retrospective calculation or comparison is impossible.…”

Evaluación de los índices predictores de eventos adversos en el adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad

“…Evaluar la gravedad y decidir el lugar de manejo del enfermo (ambulatorio, sala o UCI) es una decisión clínica compleja, la cual puede verse dificultada porque los médicos clínicos suelen subestimar, y a veces sobreestimar, la gravedad de la enfermedad [15][16][17] . Por este motivo, se han diseñado los índices pronósticos para ayudar a los médicos clínicos a evaluar la gravedad de los pacientes con neumonía 6,14,[24][25][26] .…”

“…(clases I a III) detectaron a los pacientes hospitalizados por neumonía con bajo riesgo de muerte (menor de 1%); mientras que las otras reglas predictoras fueron menos sensibles y específicas para definir al grupo de bajo riesgo (Tabla 2). Los índices de Fine, CURB-65 y CRB-65 permiten predecir con bastante precisión el riesgo de muerte en el paciente con neumonía 24,25 ; sin embargo, no constituyen la herramienta ideal para predecir el ingreso a UCI, la conexión a ventilador mecánico y el uso de drogas vasoactivas por shock séptico. Por este motivo, se han diseñado nuevas herramientas que incluyen variables clínicas y de laboratorio medidas en la admisión al hospital relacionadas con la gravedad de la infección pulmonar, tales como los criterios de neumonía comunitaria severa propuestos por la Sociedad Americana de Tórax 11 , SMART-COP 20 y SCAP 21 , los cuales permiten pesquisar a los pacientes con neumonía comunitaria severa y predecir la admisión a UCI, conexión a VM y el uso de drogas vasoactivas.…”

Weight of the CURB-65 Criteria for Community-Acquired Pneumonia in a Very Low-Mortality-Rate Setting

“…65 years) for the prognostic assessment of CAP and 1 point is assigned for the presence of each of the criteria on admission to the hospital (4, 5). Loke's recent systematic review and metaanalysis suggest that the CURB-65 scoring system performs well at identifying patients with pneumonia that have a low risk of death (Average mortality 7.4%) (6). This good per-formance in patients with CAP was further validated by a recent large multicenter prospective observational study (7) and a retrospective cohort study (8).…”