Predicting severity of community-acquired pneumonia with expanded CURB-65 m

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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

Evidencio Community

Model ID

1042

Version

1.24

Revision date

2018-03-01

Specialty

Emergency medicine, Infectious disease, Internal medicine, Pulmonology

MeSH terms

Pneumonia

Community Acquired Infections

Mortality

Clinical Prediction Rule

Model type

Linear model ^{(Calculation)}

Status

public

Rating

★ ★ ★ ★

Formula
No Formula defined yet

Condition	Formula

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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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

	Predicting severity of community-acquired pneumonia with expanded CURB-65 model
	V-1.24-1042.18.03.01
	Refer to Intended Use for instructions before use
	Evidencio B.V., Irenesingel 19, 7481 GJ, Haaksbergen, the Netherlands

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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.

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

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Related validations

External validation in 704 patients with community-acquired pneumonia (CAP)

Validation cohort size: 704

C-Index: Not specified

Validation author: Evidencio Community

Revision date:

ROC Plot

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

Validation cohort size: 456

C-Index: Not specified

Validation author: Evidencio Community

Revision date:

ROC Plot

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Disclaimer: Calculations alone should never dictate patient care, and are no substitute for professional judgement.