Performance of early warning score and CURB-65 in predicting severe outcome in community-acquired pneumonia

Abstract

Background: CURB-65 is a well-validated severity-score for predicting mortality from pneumonia. Despite recommendations in guidelines its implementation in Danish clinical practice have been difficult. Early Warning Score (EWS) is a generic severity prediction tool, which has been implemented and obligatory throughout The Capital Region of Denmark. Objective: The study aim was to compare the performance of the CURB-65 score with that of the EWS score in predicting severe outcome in Community-acquired pneumonia (CAP). Method: A multicenter retrospective cohort study of adult patients with CAP admitted to three hospitals in the Capital Region of Denmark. Predictive associations of CURB-65, EWS, and severe outcome were analyzed using receiver operating characteristics analyses. Severe outcome in CAP was defined as need of intensive care unit (ICU) or death within 30 days. Results: 1047 patients were included with a median (IQR) age of 72 (58-82). 9.8% (n=103) died within 30 days and 9.3% (n=97) were admitted to the ICU. CURB-65 and EWS performed similarly in predicting severe outcome, with an AUC of 0.718 (95% CI 0.677-0.758) and 0.748 (95% CI 0.706-0.790) respectively. Whereas CURB-65 performed better in mortality prediction, EWS performed better in identifying patients with high risk of ICU admittance. ICU admittance was predicted with an AUC of 0.790 (0.744-0.836) and 0.651 (0.594-0.708) for EWS and CURB-65, respectively. Conclusion: EWS and CURB-65 had similar performance in predicting severe outcome in CAP. CURB-65 performed better in mortality prediction, while EWS was a better predicter of ICU admittance. Further research to identify better generic prognostic tools is required.