Marc Andre Pflug1, Timothy Tiutan2, Thomas Wesemann3, Harald Nüllmann3, Hans Jürgen Heppner4, Ludger Pientka3, Ulrich Thiem5. 1. School of Medicine, University of Bochum, Bochum, Germany. 2. College of Medicine, University of Arizona, Tucson, USA. 3. Department of Geriatrics, Marienhospital Herne, University of Bochum, Herne, Germany. 4. Department of Geriatrics, HELIOS Klinikum Schwelm, University of Witten/Herdecke, Schwelm, Germany. 5. Department of Geriatrics, Marienhospital Herne, University of Bochum, Herne, Germany Department of Medical Informatics, Biometry and Epidemiology, University of Bochum, Bochum, Germany.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Peter D Sottile; David Albers; Peter E DeWitt; Seth Russell; J N Stroh; David P Kao; Bonnie Adrian; Matthew E Levine; Ryan Mooney; Lenny Larchick; Jean S Kutner; Matthew K Wynia; Jeffrey J Glasheen; Tellen D Bennett Journal: J Am Med Inform Assoc Date: 2021-10-12 Impact factor: 4.497
Authors: Christian Theilacker; Ralf Sprenger; Friedhelm Leverkus; Jochen Walker; Dennis Häckl; Christof von Eiff; Julia Schiffner-Rohe Journal: PLoS One Date: 2021-06-15 Impact factor: 3.240