Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia

Details

Serval ID
serval:BIB_17BDFFF5B332
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia
Journal
American Journal of Medicine
Author(s)
Aujesky  D., Auble  T. E., Yealy  D. M., Stone  R. A., Obrosky  D. S., Meehan  T. P., Graff  L. G., Fine  J. M., Fine  M. J.
ISSN
0002-9343 (Print)
Publication state
Published
Issued date
04/2005
Volume
118
Number
4
Pages
384-92
Notes
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S. --- Old month value: Apr
Abstract
PURPOSE: We assessed the performance of 3 validated prognostic rules in predicting 30-day mortality in community-acquired pneumonia: the 20 variable Pneumonia Severity Index and the easier to calculate CURB (confusion, urea nitrogen, respiratory rate, blood pressure) and CURB-65 severity scores. SUBJECTS AND METHODS: We prospectively followed 3181 patients with community-acquired pneumonia from 32 hospital emergency departments (January-December 2001) and assessed mortality 30 days after initial presentation. Patients were stratified into Pneumonia Severity Index risk classes (I-V) and CURB (0-4) and CURB-65 (0-5) risk strata. We compared the discriminatory power (area under the receiver operating characteristic curve) of these rules to predict mortality and their accuracy based on sensitivity, specificity, predictive values, and likelihood ratios. RESULTS: The Pneumonia Severity Index (risk classes I-III) classified a greater proportion of patients as low risk (68% [2152/3181]) than either a CURB score <1 (51% [1635/3181]) or a CURB-65 score <2 (61% [1952/3181]). Low-risk patients identified based on the Pneumonia Severity Index had a slightly lower mortality (1.4% [31/2152]) than patients classified as low-risk based on the CURB (1.7% [28/1635]) or the CURB-65 (1.7% [33/1952]). The area under the receiver operating characteristic curve was higher for the Pneumonia Severity Index (0.81) than for either the CURB (0.73) or CURB-65 (0.76) scores (P <0.001, for each pairwise comparison). At comparable cut-points, the Pneumonia Severity Index had a higher sensitivity and a somewhat higher negative predictive value for mortality than either CURB score. CONCLUSIONS: The more complex Pneumonia Severity Index has a higher discriminatory power for short-term mortality, defines a greater proportion of patients at low risk, and is slightly more accurate in identifying patients at low risk than either CURB score.
Keywords
Aged Blood Pressure Blood Urea Nitrogen Community-Acquired Infections/*mortality Confusion Female Humans Male Middle Aged Pneumonia/*mortality Prognosis Prospective Studies ROC Curve Respiratory Physiologic Phenomena Sensitivity and Specificity Severity of Illness Index
Pubmed
Web of science
Create date
25/01/2008 13:38
Last modification date
20/08/2019 12:47
Usage data