Comparison of severity scoring systems A-DROP and CURB-65 for community-acquired pneumonia.
OBJECTIVE
The initial assessment of the severity of community-acquired pneumonia (CAP) is important for patient management. The Japanese Respiratory Society (JRS) has proposed a 6-point scale (0-5) to assess the clinical severity of CAP. The A-DROP scoring system assesses the following parameters: (i) Age (male >or= 70 years, female >or= 75 years); (ii) Dehydration (blood urea nitrogen (BUN) >or= 210 mg/L); (iii) Respiratory failure (SaO(2) <or= 90% or PaO(2) <or= 60 mm Hg); (iv) Orientation disturbance (confusion); and (v) low blood Pressure (systolic blood pressure <or= 90 mm Hg). A-DROP is a modified version of CURB-65 (confusion, BUN > 7 mmol/L (200 mg/L), respiratory rate >or= 30/min, low blood pressure (diastolic <or= 60 mm Hg or systolic < 90 mm Hg, and age >or= 65 years) proposed by the British Thoracic Society. However, validation of A-DROP has not been attempted nor has it been compared with CURB-65. The aim of this study was to confirm that A-DROP is equivalent to CURB-65 for predicting severity of CAP.


METHODS
A retrospective observational study was conducted of patients with CAP hospitalized at a single centre between November 2005 and January 2007. The 30-day mortality after admission was compared following assessment of severity using the A-DROP and CURB-65 scoring systems.


RESULTS
Three-hundred and twenty-nine patients were evaluated. The areas under the receiver operating characteristic curves were 0.846 (95% confidence interval (CI): 0.790-0.903) and 0.835 (95% CI: 0.763-0.908) for A-DROP and CURB-65, respectively.


CONCLUSIONS
The JRS A-DROP can be used to assess severity of CAP, and gives similar results to CURB-65.
Shindo
Yuichiro
Y
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. yshindo@mbe.ocn.ne.jp
Sato
Shinji
S
Maruyama
Eiichi
E
Ohashi
Takamasa
T
Ogawa
Masahiro
M
Imaizumi
Kazuyoshi
K
Hasegawa
Yoshinori
Y
D000367:Age Factors; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D003221:Confusion / Q000503:physiopathology; D003681:Dehydration / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000503:physiopathology; D007564:Japan; D011014:Pneumonia / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D012107:Research Design; D012131:Respiratory Insufficiency / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012955:Societies, Medical; D006113:United Kingdom