The modified APACHE II score outperforms Curb65 pneumonia severity score as a predictor of 30-day mortality in patients with methicillin-resistant Staphylococcus aureus pneumonia.
OBJECTIVE
To compare the predictive accuracy for 30-day mortality of the CURB65 score adopted by the British Thoracic Society and the simpler CRB65 score to APACHE (acute physiology and chronic health evaluation) II in patients with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.


METHODS
A retrospective, single-center, observational cohort study.


METHODS
Barnes-Jewish Hospital, a 1,200-bed urban teaching hospital.


METHODS
Adult patients requiring hospitalization identified to have MRSA pneumonia.


METHODS
Retrospective data collection from automated hospital, microbiology, and pharmacy databases.


RESULTS
Two hundred eighteen patients with MRSA pneumonia were identified over a 3-year period. Forty-four patients (20.2%) died during hospitalization. All three prediction rules had high negative predictive values but relatively low positive predictive values at most cut-off points examined. APACHE II had the greatest area under the receiver operating characteristic curve (0.805; 95% confidence interval [CI], 0.743 to 0.866) compared to CURB65 (0.634; 95% CI, 0.541 to 0.727) and CRB65 (0.643; 95% CI, 0.546 to 0.739) [p < 0.05 for both comparisons]. Similar results were obtained when the subgroups of community-acquired MRSA pneumonia and health-care-associated MRSA pneumonia were examined separately.


CONCLUSIONS
APACHE II outperformed CURB65 and CRB65 for initial prognostic assessment in MRSA pneumonia.
Kollef
Katherine E
KE
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Ave, St. Louis, MO 63110, USA.
Reichley
Richard M
RM
Micek
Scott T
ST
Kollef
Marin H
MH
D018806:APACHE; D000328:Adult; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013211:Staphylococcus aureus / Q000187:drug effects; D016019:Survival Analysis