Performance of CURB-65 and CURB-age in community-acquired pneumonia.
BACKGROUND
Community-acquired pneumonia (CAP) is common and associated with significant mortality. In this study, we validated a newly proposed severity assessment rule for CAP, CURB-age, and also compared with to the currently recommended criteria in UK, CURB-65.


METHODS
We conducted a prospective study in three hospitals in Norfolk and Suffolk, UK. One hundred and ninety patients were included and followed up for 6 weeks.


RESULTS
Of 190 patients, 100 were men (53%). The age range was 18-101 years (median 76 years). Sixty-five (34%) had severe pneumonia by CURB-65 and 54 (28%) had severe pneumonia by CURB-age. There were 54 deaths during follow-up. There were 32 deaths (50%) in severe and 22 deaths (18%) in non-severe group by CURB-65. There were 27 deaths each in both the groups by CURB-age (50% of severe cases and 20% of non-severe cases). For CURB-65, sensitivity, specificity, and positive and negative predictive values were 59.3% (45.0-72.4), 75.7% (67.6-82.7), 49.2% (36.6-61.9) and 82.4% (74.6-88.6), respectively. For CURB-age, the respective values were 50.0% (31.1-63.9), 80.1% (72.4-86.5), 50.0% (36.1-63.9) and 80.1% (72.4-86.5). Exclusion of patients aged < 65 years did not alter the results.


CONCLUSIONS
Despite better specificity in correctly identifying 6-week mortality for CAP, CURB-age appears to be less sensitive than CURB-65. Our findings further assure the usefulness of CURB-65 for predicting mortality in CAP.
Myint
P K
PK
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK. Phyo.K.Myint@uea.ac.uk
Sankaran
P
P
Musonda
P
P
Subramanian
D N
DN
Ruffell
H
H
Smith
A C
AC
Prentice
P
P
Tariq
S M
SM
Kamath
A V
AV
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000401:mortality*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index