Assessment of oxygenation and comorbidities improves outcome prediction in patients with community‐acquired pneumonia with a low CRB‐65 score
- 13 February 2015
- journal article
- Published by Wiley in Journal of Internal Medicine
- Vol. 278 (2), 193-202
- https://doi.org/10.1111/joim.12349
Abstract
Addition of assessment of comorbid diseases ('D') and oxygen saturation ('S') to the CRB-65 score has been recommended to improve its accuracy for risk stratification in community-acquired pneumonia (CAP). The aim of this study was to validate the resulting DS-CRB-65 score in a large cohort of patients with CAP.A total of 4432 patients prospectively enrolled in the CAPNETZ cohort were included in this study. Predefined end points were 28-day mortality, requirement for mechanical ventilation or vasopressors (MV/VS) and requirement for MV/VS or intensive care unit admission (MV/VS/ICU). Receiver operating characteristic curve analysis was used to determine the accuracy of the CRB-65 score and the addition of D (extra-pulmonary comorbidities) and S (oxygen saturation <90% or partial pressure of oxygen <8 kPa). Binary logistic regression and the method of Hanley and McNeil were used to compare the criteria.The mortality rate was 4.0%, and 4.2% of patients required MV/VS and 6.6% required MV/VS/ICU. After multivariate analysis, D and S independently were added to the CRB-65 criteria for mortality prediction, but only S improved prediction of MV/VS and MV/VS/ICU (P < 0.001 for all). The area under the curve of the CRB-65 score was significantly improved by adding D and S for all end points (P < 0.02). Amongst patients who died or required MV/VS despite a CRB-65 score of 0, 64-80% would have been identified by the DS-CRB-65 score.The addition of assessment of oxygenation and comorbidities significantly improved the prognostic accuracy of the CRB-65 score. Consequently, the DS-CRB-65 score may have a useful role in risk stratification algorithms for CAP.Keywords
Funding Information
- Bundesministerium für Bildung und Forschung (01KI07145)
This publication has 30 references indexed in Scilit:
- Prediction of in-hospital death from community-acquired pneumonia by varying CRB-age groupsEuropean Respiratory Journal, 2012
- Guidelines for the management of adult lower respiratory tract infections - Full versionClinical Microbiology & Infection, 2011
- Validation of the Infectious Diseases Society of America/American Thoratic Society Minor Criteria for Intensive Care Unit Admission in Community-Acquired Pneumonia Patients Without Major Criteria or Contraindications to Intensive Care Unit CareClinical Infectious Diseases, 2011
- Predicting mortality with severity assessment tools in out-patients with community-acquired pneumoniaQJM: An International Journal of Medicine, 2011
- Validity of British Thoracic Society guidance (the CRB-65 rule) for predicting the severity of pneumonia in general practice: systematic review and meta-analysisBritish Journal of General Practice, 2010
- Value of severity scales in predicting mortality from community-acquired pneumonia: systematic review and meta-analysisThorax, 2010
- Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysisThorax, 2010
- New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare qualityThorax, 2009
- CRB-65 for the assessment of pneumonia severity: who could ask for more?Thorax, 2008
- A Prediction Rule to Identify Low-Risk Patients with Community-Acquired PneumoniaNew England Journal of Medicine, 1997