title: Predicting pneumonia mortality using CURB-65, PSI, and patient characteristics in patients presenting to the emergency department of a comprehensive cancer center.
abstract: The prognostic accuracy of the CURB-65 criteria and pneumonia severity index (PSI) in immunocompromised cancer patients with pneumonia is unknown. We sought to determine whether CURB-65 and PSI predict 28-day mortality in cancer patients with pneumonia, and identify other factors that predispose cancer patients with pneumonia to a high mortality risk. We assessed sensitivities, specificities, predictive values, and areas under the receiver operating curve area under the curve (AUC) of the CURB-65 and PSI in predicting the 28-day mortality of cancer patients presenting to our institution's emergency department with pneumonia. We used the DeLong and Clarke-Pearson approach to determine whether the addition of other risk factors improved the scales' performances. The overall and pneumonia-related 28-day mortality rates were 20.2% (n = 44) and 17.4% (n = 38), respectively. In predicting 28-day mortality, the CURB-65 score had sensitivity of 45% and specificity of 81%, and the PSI score had sensitivity of 82% and specificity of 34%. The CURB-65 and PSI discriminated poorly between fatal and nonfatal pneumonia cases (AUCs, 0.664 and 0.658, respectively; 95% confidence interval [CI], 0.57-0.75 for each). The addition of radiation therapy (RT) within 4 weeks and stem cell transplant (SCT) significantly improved the AUCs of the CURB-65 (0.75; 95% CI, 0.67-0.83) and PSI (0.73; 95% CI, 0.65-0.82). Inadequate performances of CURB-65 and PSI demonstrate that a tool for predicting pneumonia-related mortality in cancer patients and other immunocompromised populations is needed. Pneumonia patients who have undergone recent RT or (SCT) are at a high risk of dying from pneumonia and require special consideration when assessing pneumonia-related mortality risk.
authors.affiliation: Department of Emergency Medicine, Division of Internal Medicine, UT MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, 77030, Texas.
authors.forename: Carmen
authors.initials: C
authors.lastname: Gonzalez
authors.forename: Tami
authors.initials: T
authors.lastname: Johnson
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rolston
authors.forename: Kelly
authors.initials: K
authors.lastname: Merriman
authors.forename: Carla
authors.initials: C
authors.lastname: Warneke
authors.forename: Scott
authors.initials: S
authors.lastname: Evans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy; D016522:Oncology Service, Hospital; D011014:Pneumonia / Q000401:mortality* / Q000473:pathology; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: CURB-65; Cancer; PSI; emergency department; pneumonia