title: Short-term mortality of adult inpatients with community-acquired pneumonia: external validation of a modified CURB-65 score.
abstract: OBJECTIVE
  The management of community-acquired pneumonia (CAP) continues to be a challenge, especially in older people. To enable better risk stratification, a variation of the severity scores CRB-65 and CURB-65, called CURB-age, has been suggested. We compared the association between risk groups as defined by the scores and 30-day mortality for a cohort of mainly older inpatients with CAP.
  
  
  METHODS
  We retrospectively analysed data from the CAP database from the years 2005 to 2009 of a single centre in Herne, Germany. Patient characteristics, criteria values within the severity scores CURB-65, CRB-65 and CURB-age, and 30-day mortality were assessed. We compared the association between score points and score-defined risk groups and mortality. Sensitivity and specificity with corresponding 95% CIs were calculated, and receiver operating characteristic (ROC) curve analysis was performed.
  
  
  RESULTS
  Data from 559 patients were analysed (mean age 74.1 years, 55.3% male). Mortality at day 30 was 10.9%. CURB-age included more patients in the low-risk category than CRB-65 (195 vs 89), and the patient group had a lower mortality (2.6% vs 3.4%). When compared with CURB-65, CURB-age included slightly fewer patients (195 vs 214) with lower mortality (2.6% vs 4.2%). CURB-age sorted the most patients who died within 30 days into the high-risk CAP group (CURB-age, 32; CURB-65, 28; CRB-65, 9), which had the highest mortality (CURB-age, 26.4%; CURB-65, 19.4%; CRB-65, 21.4%). Advantages of CURB-age categories were depicted through ROC curve analysis (area under the curve 0.73 (95% CI 0.67 to 0.79) for CURB-age categories, 0.67 (95% CI 0.60 to 0.74) for CURB-65 categories, and 0.59 (95% CI 0.52 to 0.66) for CRB-65 categories).
  
  
  CONCLUSIONS
  In comparison with CRB-65 and CURB-65, risk stratification as defined by CURB-age showed the closest association with 30-day mortality in our sample. Further prospective studies are needed to assess the potential of CURB-age for better risk prediction, especially in older patients with CAP.
authors.affiliation: School of Medicine, University of Bochum, Bochum, Germany.
authors.forename: Marc Andre
authors.initials: MA
authors.lastname: Pflug
authors.affiliation: College of Medicine, University of Arizona, Tucson, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Tiutan
authors.affiliation: Department of Geriatrics, Marienhospital Herne, University of Bochum, Herne, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wesemann
authors.affiliation: Department of Geriatrics, Marienhospital Herne, University of Bochum, Herne, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Nüllmann
authors.affiliation: Department of Geriatrics, HELIOS Klinikum Schwelm, University of Witten/Herdecke, Schwelm, Germany.
authors.forename: Hans Jürgen
authors.initials: HJ
authors.lastname: Heppner
authors.affiliation: Department of Geriatrics, Marienhospital Herne, University of Bochum, Herne, Germany.
authors.forename: Ludger
authors.initials: L
authors.lastname: Pientka
authors.affiliation: Department of Geriatrics, Marienhospital Herne, University of Bochum, Herne, Germany Department of Medical Informatics, Biometry and Epidemiology, University of Bochum, Bochum, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Thiem
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001806:Blood Urea Nitrogen; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000401:mortality*; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000592:standards*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult
keywords: CURB-65; CURB-age; INFECTIOUS DISEASES; community-acquired pneumonia; risk prediction