Prognostic values of pneumonia severity index, CURB-65 and expanded CURB-65 scores in community-acquired pneumonia in Zagazig University Hospitals

Abstract

IntroductionAssessment of severity and site of care decisions for community-acquired pneumonia patients (CAP) are very important for patients’ safety and optimal use of resources. Late admission to the intensive care unit (ICU) leads to increase the rate of mortality in CAP. We aimed to evaluate the effectiveness of the new expanded CURB-65 score in comparison with other pneumonia severity scoring systems (PSI, CURB-65) in predicting CAP patients’ outcomes. Methodsa prospective study included 250 consecutive patients hospitalized for CAP at Chest and Tropical medicine Departments and ICUs at Zagazig University Hospitals, Egypt in the period between May 2016 and November 2016. ResultsThe mean age of patients was 59.17±14.04years, 56% of all patients had comorbid diseases. As regards patients, outcomes (ICU admission rate, the median length of hospital stay, the overall 30-day mortality rate and need for invasive mechanical ventilation) were 29.6%, 8days 11.2% and 23.6% respectively. COPD and liver cirrhosis were significantly associated with increased the 30-day mortality in our CAP patients. Mortality rate increased with the severity of liver cirrhosis. In the multivariate analysis (age⩾65years, LDH>230u/L, Albumin<3.5g/dL, Platelet count<100×109/L, SBP<90mmHg or DBP⩽60mmHg, septic shock and Confusion) were the independent predictors of the 30-day mortality. Expanded CURB-65 was correlated with severity of liver disease guided by Child Pugh score (r (0.34), p-value (0.01). The 30-day mortality was lower in expanded CURB-65 score (1–4) about 4.1% than PSI class (I–III) and CURB-65 score (0–2). While, the 30-day mortality was higher in expanded CURB-65 score (5–8) about 25.9% than PSI class (IV–V) 14.2% and lastly CURB-65 score (3–5) 18.4%. Expanded CURB-65 score (5–8) was associated with more frequent ICU admission about 49.4% than other two scores. The expanded CURB-65 scoring system was the best predictor of 30-day mortality, ICU admission and need for mechanical ventilation in CAP patients as it had the highest sensitivity, negative predictive value and largest area under the ROC curve. ConclusionsExpanded CURB-65 score is simple, objective and more accurate scoring system for evaluation of CAP severity and can improve the efficiency of predicting the mortality in CAP patients, better than CURB-65 and PSI scores. Also, Expanded CUEB-65 may generate new therapeutic and prognostic modality in CAP especially in patients with liver cirrhosis.