The predictive role of enhanced CURB score in patients with pneumonia during combined immunosuppression treatment

Abstract

Objective To explore the predictive value of enhanced CURB score in the prognosis of patients with community-acquired pneumonia (CAP) in the setting of immunosuppressive therapy. Methods Retrospective study of 156 CAP patients with diseases treated with immunosuppressive agents admitted from January 2012 to July 2016 was carried out. The patients were divided into survival group and death group, and comparisons of demographics of patients and clinical sitting between two groups were performed. The receiver operator characteristic(ROC) curve was used for the calculations of enhanced CURB score, CURB-65 score and qSOFA score measured to predict the 28-day outcome of patients as the clinical observation endpoint. The predictive value of three scoring systems was compared in the prognosis of CAP patients under immunosuppressive treatment using the area under the curve (AUC). Results Of 156 patients, there were 134 patients in survival group and 22 patients in death group. The statistically significant differences in measured results of three scoring systems between two groups were as follows: enhanced CURB score [8(6, 10) vs. 12(9, 13)], CURB-65 score [1(0, 2) vs. 2(2, 3)], and sSOFA score [0(0, 1) vs. 1(0, 1)] (P<0.05 in 3 scoring systems). According to ROC, the AUC of enhanced CURB score was 0.815, with sensitivity 50%, specificity 97.01%, the optimal cut-off value 11 (P<0.01); the AUC of CURB-65 score was 0.816, with sensitivity 81.82%, specificity 65.67%, the best cut-off value 1 (P<0.01); the AUC of qSOFA score was 0.642, with sensitivity 54.5%, specificity 73.1%, the best cut-off value 0 (P<0.01). There was a significant difference in score between qSOFA score and CURB-65 score, between qSOFA score and enhanced CURB score, but no significant difference between enhanced CURB score and CURB-65 score. Conclusions The enhanced CURB score has preferable predictive value in evaluating the prognosis of CAP patients during immunosuppressive treatment. Though its sensitivity is low, its specificity is superior to CURB-65 score and qSOFA score. Key words: Community-acquired pneumonia; Immunosuppression; CURB-65; Enhanced CURB; qSOFA