[Ability of the modified CRB75 severity scale in assessing elderly patients with community acquired pneumonia].
OBJECTIVE
To compare the ability of the classic CRB65 (confusion, respiratory rate, blood pressure and age ≥65 years) vs the modified CRB-75 for the severity assessment of patients 65 years or older with community acquired pneumonia (CAP).


METHODS
Prospective cohort study.


METHODS
Tarragona Health Region.


METHODS
A total of 350 patients ≥65 years with a radiographically confirmed CAP (hospitalized or outpatient) during 2008-2010.


METHODS
The CRB-65 score (confusion; respiratory rate ≥30; systolic blood pressure <90 mmHg or diastolic ≤ 60 mmHg; age ≥65 years) and the modified CRB-75 (similar criteria but age ≥75 years) were calculated at the time of diagnosis, and 30-day mortality was considered as the main dependent variable.


RESULTS
The overall 30-day mortality rate was 13.1% (4% in outpatient CAP and 15% in hospitalized CAP). According to CRB-65, mortality was 7,7% with a score of 1, 22.5% with a score of 2, and 50% with a score of 3 (no cases with a score of 4). Mortality also directly increased according to CRB-75, being 3,2% with a score of 0, 9,7% with a score of 1, 30.0% with a score of 2, and 45.5% with a score of 3. The discriminative value of both CRB65 and CRB75 rules to classify risk of short-term mortality among our study population was acceptable, with a better area under receive operating characteristic curve (ROC) for CRB75 than for CRB-65 (0,735 vs 0,681; P<.01).


CONCLUSIONS
Both CRB-65 and CRB-75 scales are an acceptable tool to classify mortality risk among elderly patients with CAP. However, CRB-75 can be more useful for evaluating patients over 65 years with CAP.
Dirección de Atención Primaria del Camp de Tarragona, Institut Català de la Salut, Tarragona, España. oochoa.tarte.ics@gencat.cat
Olga
O
Ochoa Gondar
Angel
A
Vila Córcoles
Teresa
T
Rodriguez Blanco
Cinta
C
de Diego Cabanes
Elisabet
E
Salsench Serrano
Inmaculada
I
Hospital Guardiola
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001794:Blood Pressure; D017714:Community-Acquired Infections / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D003221:Confusion / Q000209:etiology; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D056152:Respiratory Rate; D012720:Severity of Illness Index