title: Expanded CURB-65: a new score system predicts severity of community-acquired pneumonia with superior efficiency.
abstract: Aim of this study was to develop a new simpler and more effective severity score for community-acquired pneumonia (CAP) patients. A total of 1640 consecutive hospitalized CAP patients in Second Affiliated Hospital of Zhejiang University were included. The effectiveness of different pneumonia severity scores to predict mortality was compared, and the performance of the new score was validated on an external cohort of 1164 patients with pneumonia admitted to a teaching hospital in Italy. Using age ≥ 65 years, LDH > 230 u/L, albumin < 3.5 g/dL, platelet count < 100 × 10(9)/L, confusion, urea > 7 mmol/L, respiratory rate ≥ 30/min, low blood pressure, we assembled a new severity score named as expanded-CURB-65. The 30-day mortality and length of stay were increased along with increased risk score. The AUCs in the prediction of 30-day mortality in the main cohort were 0.826 (95% CI, 0.807-0.844), 0.801 (95% CI, 0.781-0.820), 0.756 (95% CI, 0.735-0.777), 0.793 (95% CI, 0.773-0.813) and 0.759 (95% CI, 0.737-0.779) for the expanded-CURB-65, PSI, CURB-65, SMART-COP and A-DROP, respectively. The performance of this bedside score was confirmed in CAP patients of the validation cohort although calibration was not successful in patients with health care-associated pneumonia (HCAP). The expanded CURB-65 is objective, simpler and more accurate scoring system for evaluation of CAP severity, and the predictive efficiency was better than other score systems.
authors.affiliation: Department of Infectious Diseases, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Jin-liang
authors.initials: JL
authors.lastname: Liu
authors.affiliation: Department of Infectious Diseases, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Xu
authors.affiliation: Department of Infectious Diseases, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Experimental Medical Class 1102, Chu Kochen Honor College, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Department of Infectious Diseases, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Xue-jie
authors.initials: XJ
authors.lastname: Wu
authors.affiliation: Department of Infectious Diseases, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Ling-xian
authors.initials: LX
authors.lastname: Shi
authors.affiliation: Department of Infectious Diseases, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Rui-qing
authors.initials: RQ
authors.lastname: Lu
authors.affiliation: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Farcomeni
authors.affiliation: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Venditti
authors.affiliation: Department of Infectious Diseases, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Ying-li
authors.initials: YL
authors.lastname: Zhao
authors.affiliation: Department of Infectious Diseases, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Shu-ya
authors.initials: SY
authors.lastname: Luo
authors.affiliation: Department of Infectious Diseases, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Xiao-jun
authors.initials: XJ
authors.lastname: Dong
authors.affiliation: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Falcone
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis*; D002681:China / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000378:metabolism / Q000401:mortality*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000378:metabolism / Q000401:mortality*; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers