Predicting severity of community-acquired pneumonia with expanded CURB-65 model
The expanded CURB-65 score was developed as a simple and more effective severity score for community-acquired pneumonia (CAP) patients.
Research authors: Liu J, Xu F, Zhou XJ, Shi LX, Lu RQ, Farcomeni A, Venditti M, Zhao YL, Luo SY, Dong XJ, and Falcone M.
Details Formula Study characteristics Files & References
★★★★
Model author
Model ID
1042
Version
1.24
Revision date
2018-03-01
MeSH terms
  • Pneumonia
  • Community Acquired Infections
  • Mortality
  • Clinical Prediction Rule
  • Model type
    Linear model (Calculation)
    Status
    public
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    Formula
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    Additional information

    Background:
    Aim of this study was to develop a new simpler and more effective severity score for community-acquired pneumonia (CAP) patients.

    Methods:
    A total of 1640 consecutive hospitalized CAP patients in Second Affiliated Hospital of Zhejiang University were included. The effectiveness of different pneumonia severity scores to predict mortality was compared, and the performance of the new score was validated on an external cohort of 1164 patients with pneumonia admitted to a teaching hospital in Italy.

    Model development:
    Using age ≥65 years, LDH >230 u/L, albumin <3.5 g/dL, platelet count <100×10^9/L, confusion, urea >7 mmol/L, respiratory rate ≥30/min, low blood pressure, we assembled a new severity score named as expanded-CURB-65.

    Results:
    The 30-day mortality and length of stay were increased along with increased risk score. The AUCs in the prediction of 30-day mortality in the main cohort were 0.826 (95% CI, 0.807–0.844), 0.801 (95% CI, 0.781–0.820), 0.756 (95% CI, 0.735–0.777), 0.793 (95% CI, 0.773–0.813) and 0.759 (95% CI, 0.737–0.779) for the expanded-CURB-65, PSI, CURB-65, SMART-COP and A-DROP, respectively.

    Model performance:
    The performance of this bedside score was confirmed in CAP patients of the validation cohort although calibration was not successful in patients with health care-associated pneumonia (HCAP). The expanded CURB-65 is objective, simpler and more accurate scoring system for evaluation of CAP severity, and the predictive efficiency was better than other score systems.

    Source:
    Jin-liang Liu, Feng Xu, Hui Zhou, et al. Expanded CURB-65: a new score system predicts severity of community-acquired pneumonia with superior efficiency. Sci Rep. 2016;6: 22911.

    Study Population

    Total population size: 1640
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    Females: {{ model.numberOfFemales }}

    Continuous characteristics

    Name Mean SD Unit
    Age 64 19 years

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Age ≥65 years 881
    <65 years 759
    Cormorbidities Congestive heart failure 164
    COPD 136
    Chronic renal diseases 83
    Chronic liver diseases 41
    Cerebrovascular diseases 109
    Malignancy 75
    Diabetes mellitus 130
    Physical examination findings Confusion 85
    Respiratory rate ≥30/min 39
    Heart rate ≥125/min 36
    Hypotension SBP <90 mmHg or DPB <60 mmHg 127
    30-day mortality Dead 139
    Alive 1501

    Calculated expanded-CURB-65 score:
    ...
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    Result
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    Calculated expanded-CURB-65 score: points

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    Outcome stratification

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    Conditional information

    Result interpretation

    How this modell should be used:
    The expanded CURB-65 is a simple and effective severity score for community-acquired pneumonia (CAP) patients.

    Model performance:
    Liu et al (2016) compared the effectiveness of different pneumonia severity scores to predict mortality. The predictive efficiency of the expanded CURB-65 was deemed better than other score systems. Moreover, the clinical usefullness of the expanded CURB-65 was confirmed in an external validation cohort of 1164 patients with pneumonia. Yet, model calibration was suboptimal in patients with health care- associated pneumonia (HCAP).

    Source:
    Jin-liang Liu, Feng Xu, Hui Zhou, et al. Expanded CURB-65: a new score system predicts severity of community-acquired pneumonia with superior efficiency. Sci Rep. 2016;6: 22911.

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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    External validation in 456 patients with health care-associated pneumonia (HCAP)

    Validation cohort size: 456

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