On improving assessment of in-hospital mortality and ICU admission in community-acquired pneumonia patients using the eCURB

ABSTRACT

Assessment of severity of the disease in community-acquired pneumonia [CAP] is very important to decide the site of care. The conventional CURB-65 score is composed of five separate elements namely, Confusion, Uremia, Respiratory rate, BP, and age >/=65 years. These elements could be calculated electronically. The electronic CURB [eCURB] utilizes the 5 CURB-65 data elements as continuous, weighted variables. The aim of this study was to evaluate the performance of eCURB elements in predicting in-hospital mortality and ICU admission in comparison to the conventional CURB-65. This study was conducted upon 134 adult patients diagnosed as CAP and confirmed by radiographic findings, admitted to chest department, Assiut University Hospital, Egypt. The CURB-65 elements were retrospectively extracted from the medical records. The eCURB variables were introduced to electronically calculate the risk using the Excel appendix model [provided by Prof. Nanthan Dean, University of Utah, Salt Lake city, USA] and its predictive values and area under the receiver-operating characteristic [ROC] curve were compared with the conventional CURB-65 in predicting in-hospital mortality and the need for ICU admission. The study revealed that the conventional CURB-65 score could predict in-hospital mortality with an area under the curve [AUC] of 0.81 and the need for ICU admission with an AUC of 0.87. Using the eCURB-65 elements proved to be superior to the conventional CURB-65 in predicting in-hospital mortality with cut off point > 7.5 and an AUC of 0.83 [P < 0.0001]. Also, eCURB was better than conventional CURB-65 in predicting ICU admission with cut off point > 3.8 and an AUC of 0.89 [P < 0.0001]. Using the eCURB proved to be a valuable tool in predicting in-hospital mortality and ICU admission in patients with CAP with a significant superiority over conventional CURB-65 in both variables. Further prospective studies on a larger cohort are recommended