CUR-65 Score for Community-Acquired Pneumonia Predicted Mortality Better Than CURB-65 Score in Low-Mortality Rate Settings.
BACKGROUND
It is not clear whether low-blood pressure criterion could be removed from CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30/min, low blood pressure and age ≥65 years) score to orchestrate an improvement in identifying patients with community-acquired pneumonia (CAP) in low-mortality rate settings.


METHODS
A retrospective cohort study of 1,230 CAP patients was performed to simplify the CURB-65 scoring system by excluding low-blood pressure variable. The simplification was validated in a prospective 2-center cohort of 1,409 adults with CAP.


RESULTS
The hospital mortalities were 1.3% and 3.8% in the retrospective and prospective cohorts, respectively. The mortality rates in the 2 cohorts increased directly with the increasing scores, showing significant increased odds ratios for mortality. The pattern of sensitivity, specificity, positive predictive value and Youden's index of a CUR-65 (Confusion, Urea >7 mmol/L, Respiratory rate ≥30/min and age ≥65 years) score of ≥2 for prediction of mortality was better than that of a CURB-65 score of ≥3 in the retrospective cohort. Higher values of corresponding indices were confirmed in the validation cohort. The higher accuracy of CUR-65 score for predicting mortality was illustrated by the area under the receiver operating characteristic curve of 0.937, compared with 0.915 for CURB-65 score in the retrospective cohort (P = 0.0073). The validation cohort confirmed a similar paradigm (0.953 versus 0.907, P = 0.0002).


CONCLUSIONS
CURB-65 score could be simplified by removing low blood pressure to orchestrate an improvement in predicting mortality in CAP patients who have a low risk of death. A CUR-65 score of ≥2 might be a more valuable cutoff value for severe CAP.
Department of Primary Care (H-YL), Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China; Department of Respiratory Medicine (QG, Y-PZ, ML, X-KC, HL, H-LP, H-QY, XC, NL), Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China; Department of Respiratory Medicine (W-DS, Z-DL), Affiliated Shenzhen Hospital, Peking University, Shenzhen, Guangdong, China; Department of Radiology (L-HL, Q-ZZ), Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China; and Guangzhou Institute of Respiratory Diseases (State Key Laboratory of Respiratory Diseases) (MJ), First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
Hai-yan
HY
Li
Qi
Q
Guo
Wei-dong
WD
Song
Yi-ping
YP
Zhou
Ming
M
Li
Xiao-ke
XK
Chen
Hui
H
Liu
Hong-lin
HL
Peng
Hai-qiong
HQ
Yu
Xia
X
Chen
Nian
N
Liu
Zhong-dong
ZD
Lü
Li-hua
LH
Liang
Qing-zhou
QZ
Zhao
Mei
M
Jiang
D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000401:mortality; D003221:Confusion / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D056152:Respiratory Rate; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014508:Urea / Q000097:blood; D014511:Uremia / Q000175:diagnosis / Q000453:epidemiology
D014508:Urea