Evaluation of the performance of CURB-65 with increasing age.
There has been concern about the performance of CURB-65 in older patients with community-acquired pneumonia (CAP) and that younger patients who subsequently die are initially misclassified as having non-severe CAP. The purpose of this study was to evaluate the effect of age on the performance of CURB-65. We analysed data prospectively, collected in two UK hospitals. Patients were stratified into four age cohorts. Mortality in each cohort was then stratified by CURB-65 score. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating curve (AUROC) were calculated. Four hundred and twenty-eight patients were included. Misclassification of patients who subsequently died as non-severe CAP patients (CURB-65 score of < or =2) increased with increasing age (from 3% in the <65-year cohort to 27% in those aged >85 years). There were no deaths (0/105) in those aged <65 years who had a CURB-65 score of 0 or 1. At the British Thoracic Society cut-off for severe CAP (CURB-65 score of > or =3), CURB-65 performed best in 16-64-year-olds (PPV 0.4, NPV 0.97). The AUROC was significantly higher for the <65-year cohort in comparison with older patients (0.93 vs. 0.7, p <0.05). Clinicians should interpret the CURB-65 score with care in older patients referred to hospital with CAP. In those aged <65 years, however, CURB-65 appears to be able to identify a cohort of patients (CURB-65 score of 0 or 1) with very low mortality.
Parsonage
M
M
Hull & East Yorkshire Hospitals NHS Trust, Hull, UK.
Nathwani
D
D
Davey
P
P
Barlow
G
G
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D006113:United Kingdom; D055815:Young Adult