Disclosures The authors declare that they have no competing interests.
Comparison of three predictive rules for assessing severity in elderly patients with CAP
Article first published online: 26 SEP 2011
© 2011 Blackwell Publishing Ltd
International Journal of Clinical Practice
Volume 65, Issue 11, pages 1165–1172, November 2011
How to Cite
Ochoa-Gondar, O., Vila-Corcoles, A., Rodriguez-Blanco, T., Ramos, F., de Diego, C., Salsench, E., Gil, D., Daniel, J., Palacios, L. and Blade, J. (2011), Comparison of three predictive rules for assessing severity in elderly patients with CAP. International Journal of Clinical Practice, 65: 1165–1172. doi: 10.1111/j.1742-1241.2011.02742.x
- Issue published online: 14 OCT 2011
- Article first published online: 26 SEP 2011
- Paper received February 2011, accepted June 2011
Aim: This study compares the ability of the Pneumonia Severity Index (PSI) and the British Thoracic Society CURB-65 and CRB-65 rules in predicting short-term mortality among elderly patients with community-acquired pneumonia (CAP).
Methods: It is a population-based study including all people over 65 years old with a radiographically confirmed CAP in the region of Tarragona (Spain) between 2002 and 2008. Treatment setting and clinical variables were considered for each patient. PSI, CURB-65 and CRB-65 scores were calculated at the moment of diagnosis and 30-day mortality was considered as a main dependent variable. The rules were compared based on sensitivity, specificity and area under the receiver operating characteristic curve (AUC).
Results: Of the total 590 CAP cases, mortality rate was 13.6% (15.3% in hospitalised and 1.4% in outpatient cases; p = 0.001). Mortality increased with increasing PSI score (None in class II, 6,9% in class III, 14,4% in class IV and 29,5% in class V), CURB-65 score (7.5%, 14.5%, 26.7%, 53.3% and 100% for scores 1,2,3,4 and 5 respectively) and CRB-65 score (6.6%, 26.1%, 40.5% and 50% for scores 1,2,3 and 4 respectively). The three rules performed too similarly to predict 30-day mortality, with a ROC area of 0.727 [95% confidence interval (CI): 0.67–0.79] for the PSI, 0.672 (95% CI: 0.61–0.74) for the CURB-65, and 0.719 (95% CI: 0.65–0.78) for the CRB-65.
Conclusion: Our data shows that the analysed rules perform equally well among elderly people with CAP which supports the recommendation for using the simplified CRB-65 severity score among elderly patients in primary care or emergency visits.