A retrospective and comparative study between quick sequential organ failure assessment, CURB-65, and early warning scorings in COVID-19 patients to predict the disease severity and outcome

Background: Predicting the severity of COVID-19 infection in advance is the key to success of its treatment outcome. Various scoring systems are used to detect the severity of this disease but this study targets three simple scoring systems based on the vital parameters and basic routine laboratory tests. Aims and Objectives: The aim of the study was to assess the predictability of three scoring systems (Quick sequential organ failure assessment [q SOFA], CURB-65, and Early Warning scoring system) for disease severity at presentation in a rural-based tertiary care center. Materials and Methods: An observational, descriptive, retrospective, and cross-sectional study was conducted at Diamond Harbour Government Medical College Covid Hospital from January 2021 to January 2022 to assess the predictability of q SOFA, CURB-65, and Early Warning scoring system for disease severity at presentation. Results: The total number of participants was 561 among total admitted 1367 patients. A short descriptive analysis obtained from the variables to analyze the scorings howed among total sample collected, 57% were male and 43% were female. In this study, 87% of patients were survived and the rest 13% succumbed (death). There is no statistically significant difference in mortality between both genders. Age, pulse rate, and respiratory rate have a significant correlation with the outcome and altered sensorium is also highly associated with mortality. The accuracy was also found to be little higher for National Early Warning score (NEWS) score than CURB-65 scoring and q SOFA scoring (0.919, 0.914 and 0.907). Although all the scoring systems have high sensitivity (>90%) (CURB 65: Most sensitive [0.99]), the specificities of all three scoring systems are below 50%. Among these three-scoring systems, NEWS showed the highest specificity (0.492) than q SOFA (0.423) and CURB 65 (0.394). Conclusion: We suggest NEWS score and CURB-65 as a better predictor for in-hospital mortality in COVID-19 patients as it is significantly sensitive and reasonably specific. It can be recommended in less equipped hospitals where only basic laboratory facilities are available. qSOFA can be utilized where no laboratory facility is available like in safe home and isolation centers.

Comparative study of CURB-65 and expanded CURB-65 score in community acquired pneumonia in a tertiary care hospital of Assam

Background:Community acquired pneumonia is one of the leading causesof morbidityand mortality in developing countries like India. The presentation of CAP may range from mild pneumonia characterized only by fever and productive cough to severe pneumonia leading to respiratory distress and sepsis syndrome requiring management in ICU. Any delay in ICU admission has been shown to be associated with increased mortality. This study was conducted to compare Expanded CURB-65 with CURB-65 scoring system in a tertiary care centre in Assam for early stratification of patients with CAP based of severity and expected prognosis.Methods: This hospital based prospective study was conducted between September 2020 to August 2021, and a total of 100 patients were taken and followed up form admission to up to30 days. CURB65 and expanded CURB 65 score was calculated for each patientand the accuracy of each score was statistically compared.Results:In our study out of 100 patients mean age of 60�.97 with Mortality rate of 16%. Total 29% patients were need ICU care. The Sensitivity, Specificity, PPV and NPV for predicting mortality and for ICU admission of Expanded CURB-65 score is found to be superior to CURB-65 Score. Conclusions:In comparison to the CURB-65 score system, the expanded CURB-65 score prioritises both clinical and laboratory criteria and is a more reliable marker for evaluating CAP severity and may improve the effectiveness of forecasting death in CAP patients.

Decaf Score in Predicting Prognosis of Acute Exacerbation of Copd in Patient Required Hospital and ICU Admission

@#Introduction: Exacerbation refers to deterioration of patient’s respiratory indications and requires a robust scoring tool for subjects suffering from Chronic Obstructive Pulmonary Disease (COPD) undergoing acute exacerbation. The Dyspnoea, Eosinopenia, Consolidation, Acidaemia, and atrial Fibrillation (DECAF) score can be utilized bedside and predicts in-hospital mortality using indices. The study aimed at assessing the prognostic standards (of duration of ICU stay, hospital stay and mortality) and the sensitivity and specificity of acute exacerbation of COPD patients based on DECAF score. Methods: This prospective study was carried out in a tertiary hospital with 84 patients between October 2016 to September 2018. On admission, DECAF score of all patients with acute exacerbation of COPD was noted and admitted to ICU. The mean duration of stay in ICU and hospital were compared. Various components of APACHE II, BAP 65, CURB 65 were also noted on admission. Results: Mean age of population was 68.29±11.80 with male predominance (68%). The study observed mortality in 6% of patients with mean ICU stay of 3.65±2.21 days and mean hospital stay of 6.45±3.28 days. For a score of 5 and 6 mean DECAF score could not be calculated as the mortality rate was 100%. ROC of DECAF score was 0.81 which was more than APACHE II (0.72) and BAP 65 (0.69) (p-value 0.07 and 0.056 suggested significance). Conclusion: The DECAF Score has been observed to be a stronger predictor for hospital mortality. Higher the DECAF score, higher is the in-hospital death rate. The DECAF score also helps in forecasting the duration of ICU stay and hospital stay.

Construction and verification of a nomogram prediction model of severe adult community-acquired pneumonia / 中华危重病急救医学

Objective:To construct and verify the nomogram prediction model based on inflammatory indicators, underlying diseases, etiology and the British Thoracic Society modified pneumonia score (CURB-65 score) in adults with severe community acquired pneumonia (CAP).Methods:The clinical data of 172 adult inpatients first diagnosed as CAP at Taikang Xianlin Drum Tower Hospital from January 2018 to December 2021 were divided into severe and non-severe diseases groups according to the severity of their conditions. The baseline conditions (including gender, age, past history, comorbidities and family history), clinical data (including chief symptoms, onset time, CURB-65 score), first laboratory results on admission (including whole blood cell count, liver and kidney function, blood biochemistry, coagulation function, microbiological culture results) and whether the antimicrobial therapy was adjusted according to the microbiological culture results were recorded in both groups. Univariate analysis was used to screen for differential indicators between severe and non-severe patients. After covariate analysis, multi-factor Logistic regression analysis was performed based on the Aakaike information criterion (AIC) forward stepwise regression method to rigorously search for risk factors for constructing the model. Based on the results of the multi-factor analysis, a nomogram prediction model was constructed, and the discriminatory degree and calibration degree of the model were assessed using the receiver operator characteristic curve (ROC curve) and calibration curve.Results:A total of 172 adult CAP patients were included, 48 in severe group and 124 in non-severe group. The median age was 74 (57, 83) years old, onset time was 5.0 (3.0, 10.0) days, total number of comorbidities was 3 (2, 5), including 58 cases (33.7%) with hypertension and 17 (9.9%) with heart failure, 113 (65.7%) with CURB-65 score≤1, 34 cases (19.8%) had a CURB-65 score = 2 and 25 cases (14.5%) had a CURB-65 score≥3. Univariate analysis showed that there were statistically significant differences between the two groups in age, smoking history, CURB-65 score, heart rate, onset time, total comorbidity, pathogenic microorganisms, fibrinogen (FIB), D-dimer, C-reactive protein (CRP), procalcitonin (PCT), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Multi-factor Logistic regression analysis showed that hypertension [odds ratio ( OR) = 3.749, 95% confidence interval (95% CI) 1.411 to 9.962], heart failure ( OR = 4.616, 95% CI was 1.116 to 19.093), co-infection ( OR = 2.886, 95% CI was 1.073 to 7.760), history of smoking ( OR = 8.268, 95% CI was 2.314 to 29.537), moderate to high CURB-65 score ( OR = 4.833, 95% CI was 1.892 to 12.346), CRP ( OR = 1.012, 95% CI was 1.002 to 1.022), AST ( OR = 1.015, 95% CI was 1.001 to 1.030) were risk factors for severe CAP (all P < 0.05). The filtered indicators were included in the nomogram model, and the results showed that the area under the ROC curve (AUC) for the model to identify patients with severe adult CAP was 0.896, 95% CI was 0.840 to 0.937 ( P < 0.05), and the calibration curve showed that the predicted probability of severe CAP was in good agreement with the observed probability (Hosmer-Lemeshow test: χ2 = 6.088, P = 0.665). Conclusions:The nomogram model has a good ability to identify patients with severe adult CAP and can be used as a comprehensive and reliable clinical diagnostic tool to provide a evidence for timely intervention in the treatment of adults with severe CAP.

Performance of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score among patients with COVID-19 pneumonia in an emergency department triage setting: a retrospective study

ABSTRACT BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.

Predictive value of neutrophil to lymphocyte ratio and CURB-65 score in elderly patients with community acquired pneumonia / 中华急诊医学杂志

Objective:To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) and CURB-65 score in elderly patients with community acquired pneumonia (CAP).Methods:A total of 160 elderly CAP patients who were treated in Department of Respiratory and Critical Care Medicine of the Third Affiliated Hospital of Anhui Medical University between January 2019 and March 2020 were retrospectively analyzed. According to the 30-day survival, the patients were divided into the survival group ( n=127) and the death group ( n=33). The general clinical data, blood routine, liver and kidney function, blood sodium, coagulation function, C-reactive protein and procalcitonin were collected, and NLR and CURB-65 scores were calculated. Pass t-test or χ2 test was used to compare the differences of the above indexes between the two groups, and the high-risk factors of 30-day death in elderly CAP patients were screened by multivariate Logistic regression analysis; receiver operating characteristic curve (ROC) was drawn, and the predictive value of NLR and CURB-65 score on the risk of death was analyzed. Results:Compared with the survival group, the patients in the death group were older and had a higher proportion of neurological diseases and chest tightness symptoms ( P<0.05). The total number of lymphocytes, hemoglobin, and serum albumin were significantly decreased, and the total neutrophil count, blood urea nitrogen, D-dimer, NLR, C-reactive protein, procalcitonin and CURB-65 score were significantly increased in the death group (all P <0.05). Multivariate Logistic regression analysis showed that NLR and CURB-65 score were the independent risk factors of 30-day mortality in elderly CAP patients ( P<0.01). ROC survival curve showed that the area under the curve (AUC) of NLR was 0.823 [95% CI (0.747 ~ 0.900)], the cut-off value was 8.885, and the sensitivity and specificity of prognosis were 84.8% and 74.8%. The AUC of NLR combined with CURB-65 score was 0.872 [95% CI (0.801 ~ 0.942)], the cut-off value was 0.248, and the sensitivity and specificity of prognosis were 84.8% and 84.3%. The combination of the two indexes had better prognostic value than other independent evaluation indexes. Conclusions:NLR and CURB-65 scores are high risk factors of death in elderly CAP patients. The combination of the two indicators can better predict the risk of death.

A comparative study of PSI and Curb-65 scoring systems in predicting ICU admissions and mortality in cases of community-acquired pneumonia

Background:Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Despite advanced diagnostic modalities and treatment options, CAP is the fourth leading cause of death in developing countries.Several severity scores have been proposed to guide initial decision making on hospitalization and to predict the outcome. Pneumonia Severity Index (PSI) and CURB 65 are the two most widely used scoring systems to prognosticate pneumonia. Aim: To compare the efficacy of PSI and CURB 65 scoring systems inprognosticating the ICU admission and outcome in cases of CAP. Methodology: This wasan observational study conducted at a tertiary care hospital in westernMaharashtra.A hundred patients of CAP fulfilling the inclusion criteria were enrolled in the study, classified as per CURB 65 and PSI system and their outcome compared. Result: The study subjects comprised of 100 patients (64 men and 36 women) of CAP. Twenty-four patients needed ICU admission.In both PSI and CURB-65 risk scoring systems, the need for intensive care unit (ICU) admission and mortality rates increased progressively with increasing scores.PSI class ≥IV and CURB 65 ≥III had 77.52% and 40.24% sensitivity and 88.46% and 69.48% specificity respectively in predicting ICU admissions. The PSI class ≥IV had more sensitivity and specificity in predicting ICU admission than CURB-65.CURB 65 class III and IV had sensitivity86.59% and 89.64% and specificity 89.64% and 97.54% respectivelyin predicting mortality, while PSI class IV and Vhadsensitivity68.92% and 72.58% and specificity 24.74% and 54.86% respectively. CURB 65 had more sensitivity and specificity than PSI in predicting mortality. Conclusion: The PSI is better in predicting the need for ICU admission and CURB 65 is a better predictor of mortality in cases of community-acquired pneumonia.

Confusion, blood urea, respiration and blood pressure 65, pneumonia severity index and shock index and hypoxemia scores in community acquired pneumonia and outcome prediction: a descriptive study from Dr B R Ambedkar Memorial Hospital Raipur, India

Background: According to WHO, pneumonia is the third important cause of death worldwide despite various advances in medical science. Incidence of Community acquired pneumonia is about 20% to 30% in developing countries compared to 3% to 4 % in developed countries. Incidence of CAP is much higher in the very young and the elderly individuals. Objectives of the study was to compare CURB 65, PSI (Pneumonia severity index) and SIPF (shock index and hypoxemia) scores with respect to outcome prediction in community acquired pneumonia (CAP).Methods: The present hospital based descriptive observational study was conducted in the Dept of medicine, Pt. J.N.M. Medical College and Dr B. R. A. M. Hospital, Raipur, during 2016-2018 involving a total of 98 patients of community acquired pneumonia.Results: Majority of them i.e. 22 (22.4%) subjects belonged to age group 41-50 years. 34 (34.7%) subjects were found to have CURB65 score 1. 28(28.6%) subjects PSI score was noted to be class I. 89 (90.8%) subjects were discharged while, there was death of 9 (9.2%) subjects. The difference in the mean score was statistically significant (p<0.001). PSI score was found to have diagnostic sensitivity of 94.4% and specificity of 100% while CURB 65 score having 83.1% sensitivity and 100 % specificity. SIPF score had least AUC 0.88.Conclusions: Maximum diagnostic ability was noted with PSI score followed by CURB 65 and SIPF score.

Predictive accuracy of CURB-65 as comparedto PSI scorein the severity assessment of community acquired pneumonia

Introduction: Pneumonia Severity Index (PSI) and CURB-65 rule for community acquired pneumonia (CAP) have been developed to stratify patients based on mortality. Lack of a risk stratifying score like PSI or CURB-65 can lead to significant delay in starting treatment. This study was conducted to find out the ability of CURB-65 score and PSI to predict clinically relevant outcomes. Methods: 78 patients diagnosed as CAP admitted to a tertiary care hospital were enrolled into the study. Detailed clinical history was noted and CURB-65 and PSI scores were given with the help of a structured questionnaire in <24 hours of admission. The patients were revisited at day 3 and at discharge and data collected. Results:Out of 78 patients included in the study, 60 were males and 18 were females. Of the 78 patients, 14 died accounting for aninhospital mortality of 17.94%. Mortality in the mild, moderate and severe groups of CURB-65 were 0%, 16.7% and 47.8% respectively. Mortality in the mild, moderate and severe groups of PSI were 1.8%, 50% and 80% respectively. Area under the curve (AUC) for CURB-65 and PSI in terms of inhospital mortality were 0.935 and 0.920 respectively. Conclusion:The CURB-65 and PSI scores correlated well with mortality and other severity indicators. The CURB-65 has a better discriminatory power than PSI inour study. Because of its simplicity in addition to its better discriminatory power than PSI, CURB-65 may be better suited as a severity scoring system in CAP.

Prognostic value of procalcitonin combined with CURB-65 score in elderly patients with community acquired pneumonia / 中国综合临床

Objective To evaluate the value of procalcitonin (PCT) combined with CURB-65 score in the elderly patients with community acquired pneumonia(CAP). Methods Seventy-eight elderly patients with CAP were selected in the Emergency Department of Xuanwu Hospital Capital Medical University,After admission,blood routine, PCT, blood gas analysis and biochemical examination were given, and Acute Physiology and Chronic Health Evaluation(APACHEⅡ) and CURB-65 score were carried out. According to the prognosis,the patients were divided into death group (16 cases) and survival group (62 cases),The difference of PCT,white blood cell(WBC),CURB-65 score and APACHE Ⅱ score in the two groups were compared. The differences of area under ROC curve of APACHE II score,procalcitonin (PCT),CURB-65 score,PCT and CURB-65 score were compared. Results The PCT,CURB-65 and APACHEE Ⅱ scores of the death group and the survival group were (3. 35±1. 79) μg/L vs. (2. 05±1. 89) μg/L,(2. 06±0. 85) points vs. (1. 40±0. 99) points,(20. 50±4. 06) points vs. (14. 13+5. 63) points,respectively. There were significant differences between the two groups ( P＜0. 05) . The number of WBCs in survival group and survival group were ( 9. 90 ± 3. 04)×109/L and ( 8. 77 ± 3. 70)×109/L, respectively, with no significant difference between the two groups (P＝0. 263); the area under the ROC curve of PCT predicting death was 0. 716 (P＝0. 001),the area under the ROC curve of CURB-65 predicting death was 0. 679 ( P＝0. 005), and the area under the ROC curve of APACHE II score was 0. 836 (P＝0. 001) ,which was larger than PCT and CRUB-65 (P＜0. 05). The area under ROC curve of death predicted by PCT and CRUB-65 was 0. 775 (P＝0. 001). There was no significant difference between PCT and CRUB-65 and APACHE II (P＝0. 345) . Conclusion PCT combined with CURB-65 score can accurately and rapidly assess the condition of elderly patients with community-acquired pneumonia,and has important application value.

Preliminary study on the value of the new community acquired pneumonia severity index / 中华急诊医学杂志

Objective To explore the value of a new community-acquired pneumonia severity index(CPSI) in predicting the severity and mortality of patients with community-acquired pneumonia(CAP).Methods A retrospective analysis was conducted.Patients with CAP in critical care medicine of the First People's Hospital of Chenzhou were enrolled in this study.According to whether the patients died within 28 days,patients were divided into the survival group and the death group.The difference of sex,age,vital signs,blood test,the lowest Glasgow coma score (GCS) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sepsis related organ failure assessment (SOFA)score,CURB-65 (confusion,uremia,respiratory rate,BP,age 65 years) score,pneumonia severity index (PSI) score and community-acquired pneumonia severity index (CPSI) score were compared between the two groups.Logistic regression analysis was performed for the scoring systems with statistical significance in univariate analysis.The receiver operating characteristic (ROC) was drawn to analyze the prognostic value of each scoring system.Results Totally 283 patients were enrolled in this study (184 survivals and 99 deaths,mortality rate 35％).Univariate analysis showed that age,mechanical ventilation (MV) ratio,the fastest heart beat rate (HR),the lowest systolic blood pressure (SBP),the lowest mean blood pressure (MAP),pressure adjusted shock index (PASI),inspired oxygen concentration (FiO2),arterial oxygen partial pressure (PaO2),and oxygenation index (PO2/FiO2),blood urea nitrogen concentration (BUN),serum creatinine concentration (Scr),urine output,length of ICU stay,the lowest GCS,and APACHE Ⅱ score were significantly different between the two groups (P＜0.05).Multivariate regression analysis showed that CPSI score and SOFA score were independent risk factors for patients with CAP.The ROC curve of CAP patients was predicted in each scoring system,and the area under the ROC curve of CPSI score (0.728),SOFA and age score (0.708),PSI score (0.701),APACHE Ⅱ score (0.690),CURB-65 score (0.687) and SOFA score (0.683) gradually decreased.The sensitivity and specificity of the area under curve prediction showed that CPSI score was superior to the other scores.Conclusions The CPSI score can evaluate the severity of CAP patients,efficiently predict the outcome of patients with CAP,and can be widely used in clinical practice.

Prognostic Value of Procalcitonin in Pneumonia among Patients Admitted to Intensive Care Unit / 고신대학교의과대학학술지

OBJECTIVES: Pneumonia is one of the leading causes of death in the intensive care unit (ICU). Many biomarkers for predicted prognosis have been suggested; among these, procalcitonin (PCT) is known to increase in cases of bacterial infection. However, there have been many debates regarding whether PCT is an appropriate prognostic marker for pneumonia. Therefore, we investigated whether PCT can serve as a biomarker for pneumonia, and compared it with CURB-65, which is a known tool for predicting the prognosis of pneumonia. METHODS: Levels of PCT and CURB-65 scores were compared between 30-day non-survival (n = 30) and survival (n = 101) patients. Relationships between PCT and CURB-65 were determined by using linear regression analysis, as well as by using receiver operating characteristic (ROC) curve analysis and calculation of the area under the curve (AUC). High and low PCT groups were compared. RESULTS: High PCT and high CURB-65 score were positively associated with 30-day mortality. For the prediction of 30-day mortality, initial PCT and CURB-65 exhibited AUCs of 0.63 and 0.66; these were not significantly different (P = 0.132). We found that the high PCT group had a higher rate of initial treatment failure (91%, P = 0.004). CONCLUSIONS: Initial PCT can be a prognostic biomarker for mortality in severe pneumonia, similar to the CURB-65 score. Initial high PCT was positively associated with initial treatment failure.

Prognostic factors for mortality due to pneumonia among adults from different age groups in Singapore and mortality predictions based on PSI and CURB-65

<p><b>INTRODUCTION</b>Pneumonia is associated with considerable mortality. However, there is limited information on age-specific prognostic factors for death from pneumonia.</p><p><b>METHODS</b>Patients hospitalised with a diagnosis of pneumonia through the emergency department were stratified into three age groups: 18-64 years, 65-84 years and ≥ 85 years. Multivariate logistic regression and receiver operating characteristic curve analyses were conducted to evaluate prognostic factors for mortality and the performance of pneumonia severity scoring tools for mortality prediction.</p><p><b>RESULTS</b>A total of 1,902 patients were enrolled (18-64 years: 614 [32.3%]; 65-84 years: 944 [49.6%]; ≥ 85 years: 344 [18.1%]). Mortality rates increased with age (18-64 years: 7.3%; 65-84 years: 16.1%; ≥ 85 years: 29.7%; p < 0.001). Malignancy and tachycardia were prognostic of mortality among patients aged 18-64 years. Male gender, malignancy, congestive heart failure and eight other parameters reflecting acute disease severity were associated with mortality among patients aged 65-84 years. For patients aged ≥ 85 years, altered mental status, tachycardia, blood urea nitrogen, hypoxaemia, arterial pH and pleural effusion were significantly predictive of mortality. The Pneumonia Severity Index (PSI) was more sensitive than CURB-65 (confusion, uraemia, respiratory rate ≥ 30 per minute, low blood pressure, age ≥ 65 years) for mortality prediction across all age groups.</p><p><b>CONCLUSION</b>The predictive effect of prognostic factors for mortality varied among patients with pneumonia from the different age groups. PSI performed significantly better than CURB-65 for mortality prediction, but its discriminative power decreased with advancing age.</p>

Utilidad de la modificación de la Escala Curb 65 en la evaluación de severidad de la neumonía adquirida en la comunidad en pacientes adultos del área de emergencia / Utility of the CURB65 score for the evaluation of severity of community acquired pneumonia in adults of the emergency setting

La neumonía adquirida en la comunidad (NAC) es una enfermedad infecciosa frecuente y potencialmente peligrosa. La escala CURB 65 fue propuesta, para clasificar a los pacientes con NAC en grupos, determinando la necesidad de hospitalización o manejo en una unidad de cuidados intensivos y predecir la mortalidad a los 30 días. Se ha determinado que la hipoxemia en pacientes con neumonía se asocia, independientemente de las variables clínicas y radiológicas con peores resultados clínicos. Objetivo: determinar la utilidad de la modificación de la escala CURB 65 (sustitución de la uremia por saturación de 02) en la evaluación de severidad de la NAC; lo que daría origen a la escala CORB 65, e igualmente estimar el papel de la Oximetría de pulso como una variable asociada a mayor mortalidad. Métodos: estudio abierto, con una primera fase transversal de Prueba vs. Prueba y una segunda fase de seguimiento a 8 y 30 días durante Noviembre de 2017 a Marzo de 2018 en el Hospital Universitario de Los Andes, Mérida ­ Venezuela. Resultados: en este análisis en comparación al estudio original los porcentajes de mortalidad fueron mayores en todos los grupos de pacientes con las 2 escalas. La úrea plasmática presentó diferencias notables entre los promedios del grupo de vivos (37,28±25,0 mg/dL) respecto al de fallecidos (51,62±48,4 mg/dL), no existiendo significancia estadística (p=0,21). Niveles más bajos de saturación de oxígeno se encontraron en el grupo de los fallecidos 81,59%±8,1, en comparacion con el grupo de los vivos 89,06%±6,9 dicho análisis mostró un valor de p de 0,001. Conclusiones: Este estudio mostró una buena concordancia/correlación de ambas escalas, de acuerdo a los resultados de los coeficientes: D de Somers, Gamma y Rho de Spearman. Recomendamos el uso de la escala CORB65 en la evaluación y seguimiento del paciente con NAC(AU)

Community-acquired pneumonia (CAP) is a frequent and potentially dangerous infectious disease. The CURB 65 score was applied, to classify the patients with CAP in groups, according to the need of admission in a medical ward or management in an intensive care unit; This score also predicts 30-day mortality. Objective: To determine the usefulness of a modification of the CURB65 score (replacement of uremia by saturation of 02) in the severity assessment of CAP(CORB65) score, and estimating the role of pulse oximetry to assess the presence or absence of hypoxemia associated with a higher mortality. Methods: An open study in two phases was carried out, with a first transversal phase of Test vs. Test and a second phase of follow-up at 8 and 30 days, from November 2017 to March 2018. Results: Compared to the original study, the mortality percentages were higher in all groups of patients with the 2 scores. The CURB 65 score was not used to define the need of hospital admission. Adequate oxygen saturation (> 92%) was related to greater survival at 30 days. No association was found between age and mortality in the group of deceased. Conclusions: Our study showed a good concordance / correlation of both scores, according to the results of the coefficients: D of Somers, Gamma and Rho of Spearman. We recommend the use of the CORB65 score in the evaluation and follow-up of the patient with CAP(AU)

The predictive role of enhanced CURB score in patients with pneumonia during combined immunosuppression treatment / 中华急诊医学杂志

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.

The predictive role of enhanced CURB score in patients with pneumonia during combined immunosuppression treatment / 中华急诊医学杂志

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.

Evaluation of the Prognosis of Sepsis Based on the Modified CURB-65 Score / 中国医科大学学报

Objective To evaluate the prognosis of patients with sepsis in the emergency department using the modified CURB-65 score.Methods We retrospectively analyzed the clinical data of 143 patients with sepsis who were first diagnosed at the emergency department of the First Hospital of China Medical University (between January 2014 and January 2015),assessed their CURB-65 and sequential organ failure assessment (SOFA) scores,and modified the CURB-65 scoring system by adding some indexes of the prognosis of sepsis.We analyzed the prognostic value of each scoring systems in the diagnosis of sepsis using the receiver-operating characteristic curve.Results The modified CURB-65,CURB-65,and SOFA scores had independent abilities for early prediction of the prognosis of sepsis.The area under the curve and the Youden index of the modified CURB-65 score were highest,which are superior to the traditional CURB-65 and SOFA scores.Conclusion The modified CURB-65 score can predict the prognosis of sepsis in its early stage.In addition,the assessment method is simple and convenient;hence,it is useful for assessing the condition of patients with sepsis and providing an early treatment.

Evaluation on the prognostic valueof enhanced CURB and CURB-65in patients with community acquired pneumonia / 安徽医科大学学报

Objective To evaluate the prognostic value of enhanced CURB and CURB-65 score in patients with community acquired pneumonia.Methods A retrospective study was conducted among 555 patients with community-acquired pneumonia recruited.According to the patient's 28 day outcome, they were divided into effective group(n=510, 57 cured and 453 improved) and ineffective group(n=45, 30 did not improve and 15 died).The prognosis of the two groups was evaluated using the enhanced CURB and CURB-65 score, the sensitivity and specificity of the two scoring methods were compared.Results Compared with the ineffective group, the age, length of hospital stay and the prevalence of the complications of chronic diseases were significantly lower than the effective group(P<0.05).The score of enhanced CURB and CURB-65 of ineffective group were significantly higher than the effective group(P<0.05).The sensitivity of enhanced CURB score was significantly higher than that of CURB-65 (P<0.05) while its specificity was significantly lower than that of CURB-65(P<0.05).Conclusion The CURB and CURB-65 score in community acquired pneumonia can effectively assess the severity of the disease and thus guide the treatment of patients with community acquired pneumonia.

AN APPROACH TO CHEST INFECTIONS IN ADULTS

Chest infections are a diverse group of infections of the airways and lungs, the most common of which are pneumonia and acute bronchitis. A well-taken history and examination will often reveal the type of chest infection a patient has, guide the choice of antibiotics and reveal features that would prompt a referral to hospital. Many of these infections can be treated on an outpatient basis in the community. Some will need a referral for hospital admission or respiratory specialist review. This paper will cover an approach to history and examination in patients with symptoms of chest infection. Several validated tools to aid clinical decision-making will be covered and these provide evidence-based and useful guidelines to a busy family physician. This paper will also cover some current antibiotic guidelines, a patient’s journey through an emergency department visit, and some advice to patients on discharge.

Is there a correlation between co-morbidities and initial severity score of pneumonia in patients admitted with community acquired pneumonia? – a retrospective study

Background: Community-acquired pneumonia (CAP) is the most important cause of hospitalisation in Malaysia and the 6th most important cause of mortality in patients aged 65 years and above. CAP is a lower respiratory tract infection that includes signs and symptoms like cough, fever, dyspnoea, the presence of new focal chest signs and new radiographic shadowing with no prior cause. To assist clinical judgement in deciding whether to admit the patient for in-ward treatment or otherwise, the severity of CAP is most commonly graded using the CURB-65 score as the components are more readily accessible in the Accidents and Emergency Department. We believe that cardiopulmonary diseases, immunosuppressive diseases like HIV infection or diabetes mellitus and other co-morbidities may affect the severity of CAP and are thus aspects of a patients’ history that should play a more significant role in influencing a clinician’s judgement of CAP severity. The general objective of the study is therefore to identify the relationship between co-morbidities and initial severity assessment of a patient admitted for community acquired pneumonia. The 3 specific objectives are i) to determine if presence of co-morbidities affects initial severity assessment in a patient admitted with CAP ii) To identify which co-morbidities affects initial severity assessment and iii) to determine whether having multiple co-morbidities increases initial severity assessment. Methodology: A retrospective study was carried out from the month of February 2013 to July 2013 at Hospital Tuanku Ja’afar, Seremban (HTJS). Patients admitted to the four Medical wards – 6A, 6B, 7A, and 7B – from July 2012 to December 2012 and have been diagnosed with CAP were chosen. A checklist was used as a survey instrument. Using statistical analysis, the severity of CAP in patients was compared in patients with different factors like gender, different co-morbidities and the number of co-morbidities. Results: A total of 63 patients in the control group had no co-morbidities and 54 patients were of low risk, 7 patients had moderate risk, and 2 patients had high risk CAP. Of the remaining 337 patients in the sample population, 124 patients had one co-morbidity, while 213 patients had multiple co-morbidities. Among those with a single co-morbidity, 100 patients had low risk, 19 patients had moderate risk, and 5 patients had high risk CAP. For the group with multiple co-morbidities, 135 patients had low risk, 58 patients had moderate risk, and 20 patients had high risk CAP. This study found that the presence and number of co-morbidities present in a patient affected the severity of CAP. Co-morbidities like diabetes mellitus, hypertension and asthma had significant correlation to the severity of CAP in patients. The gender of the patient had no significant correlation to the severity of CAP. Conclusion: The presence and number of co-morbidities present in a patient increases the severity of CAP. Hypertension, diabetes mellitus, and asthma are comorbidities that are prerequisites for increased caution and alert when judging the severity of CAP in patients. Comparison of patients with single and multiple comorbidities showed that patients in the latter group present with higher severity scores (p-value = 0.004).