| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
|
|
|
|
|||||||||||||
|
|
|||||||||||||||
RESPIRATORY INFECTION |
1 Respiratory Infection Research Group, Respiratory Medicine, Nottingham City Hospital, Nottingham NG5 1PB, UK
2 Medical Centre Alkmaar, PO Box 501, 1800 AM Alkmaar, The Netherlands
3 Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch Hospital, Christchurch, New Zealand
4 Waikato Respiratory Department, Health Waikato, Hamilton, New Zealand
5 Division of Respiratory Medicine, Nottingham City Hospital, Nottingham NG5 1PB, UK
Correspondence to:
Correspondence to:
Dr J T Macfarlane, Respiratory Infection Research Group, Respiratory Medicine, Nottingham City Hospital, Nottingham NG5 1PB, UK;
john.macfarlane{at}tinyworld.co.uk
Background: In the assessment of severity in community acquired pneumonia (CAP), the modified British Thoracic Society (mBTS) rule identifies patients with severe pneumonia but not patients who might be suitable for home management. A multicentre study was conducted to derive and validate a practical severity assessment model for stratifying adults hospitalised with CAP into different management groups.
Methods: Data from three prospective studies of CAP conducted in the UK, New Zealand, and the Netherlands were combined. A derivation cohort comprising 80% of the data was used to develop the model. Prognostic variables were identified using multiple logistic regression with 30 day mortality as the outcome measure. The final model was tested against the validation cohort.
Results: 1068 patients were studied (mean age 64 years, 51.5% male, 30 day mortality 9%). Age 
65 years (OR 3.5, 95% CI 1.6 to 8.0) and albumin <30 g/dl (OR 4.7, 95% CI 2.5 to 8.7) were independently associated with mortality over and above the mBTS rule (OR 5.2, 95% CI 2.7 to 10). A six point score, one point for each of Confusion, Urea >7 mmol/l, Respiratory rate 30/min, low systolic(<90 mm Hg) or diastolic (
60 mm Hg) Blood pressure), age 65 years (CURB-65 score) based on information available at initial hospital assessment, enabled patients to be stratified according to increasing risk of mortality: score 0, 0.7%; score 1, 3.2%; score 2, 3%; score 3, 17%; score 4, 41.5% and score 5, 57%. The validation cohort confirmed a similar pattern.
Conclusions: A simple six point score based on confusion, urea, respiratory rate, blood pressure, and age can be used to stratify patients with CAP into different management groups.
Keywords: prediction rule; community acquired pneumonia; severity assessment
Relevant Article
Thorax 2003 58: 371.
This article has been cited by other articles:
|
|
 |
|
  A. Capelastegui, P. P. Espana, A. Bilbao, M. Martinez-Vazquez, I. Gorordo, M. Oribe, I. Urrutia, and J. M. Quintana Pneumonia: Criteria for Patient Instability on Hospital Discharge Chest, September 1, 2008; 134(3): 595 - 600. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Ewig and T. Welte CRB-65 for the assessment of pneumonia severity: who could ask for more? Thorax, August 1, 2008; 63(8): 665 - 666. [Full Text] [PDF]
|
|
|
|
|
|
J D Chalmers, A Singanayagam, and A T Hill Systolic blood pressure is superior to other haemodynamic predictors of outcome in community acquired pneumonia Thorax, August 1, 2008; 63(8): 698 - 702. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Bont, E. Hak, A. W. Hoes, J. T. Macfarlane, and T. J. M. Verheij Predicting Death in Elderly Patients With Community-Acquired Pneumonia: A Prospective Validation Study Reevaluating the CRB-65 Severity Assessment Tool Arch Intern Med, July 14, 2008; 168(13): 1465 - 1468. [Full Text] [PDF]
|
|
|
|
 |
|
 H. J Durrington and C. Summers Recent changes in the management of community acquired pneumonia in adults BMJ, June 21, 2008; 336(7658): 1429 - 1433. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Teramoto, H. Yamamoto, Y. Yamaguchi, Y. Hanaoka, M. Ishii, S. Hibi, H. Kume, and Y. Ouchi Lower respiratory tract infection outcomes are predicted better by an age >80 years than by CURB-65 Eur. Respir. J., February 1, 2008; 31(2): 477 - 478. [Full Text] [PDF]
|
|
|
|
|
|
S. Kruger, S. Ewig, R. Marre, J. Papassotiriou, K. Richter, H. von Baum, N. Suttorp, T. Welte, and on behalf of the CAPNETZ Study Group Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes Eur. Respir. J., February 1, 2008; 31(2): 349 - 355. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. E. Kollef, R. M. Reichley, S. T. Micek, and M. H. Kollef The Modified APACHE II Score Outperforms Curb65 Pneumonia Severity Score as a Predictor of 30-Day Mortality in Patients With Methicillin-Resistant Staphylococcus aureus Pneumonia Chest, February 1, 2008; 133(2): 363 - 369. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L C Jennings, T P Anderson, K A Beynon, A Chua, R T R Laing, A M Werno, S A Young, S T Chambers, and D R Murdoch Incidence and characteristics of viral community-acquired pneumonia in adults Thorax, January 1, 2008; 63(1): 42 - 48. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Christ-Crain, D. Stolz, S. Jutla, O. Couppis, C. Muller, R. Bingisser, P. Schuetz, M. Tamm, R. Edwards, B. Muller, et al. Free and Total Cortisol Levels as Predictors of Severity and Outcome in Community-acquired Pneumonia Am. J. Respir. Crit. Care Med., November 1, 2007; 176(9): 913 - 920. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. K Myint, A. V Kamath, S. L Vowler, and B. D W Harrison Simple modification of CURB-65 better identifies patients including the elderly with severe CAP Thorax, November 1, 2007; 62(11): 1015 - 1016. [Full Text] [PDF]
|
|
|
|
|
|
B. Schaaf, J. Kruse, J. Rupp, R. R. Reinert, D. Droemann, P. Zabel, S. Ewig, and K. Dalhoff Sepsis severity predicts outcome in community-acquired pneumococcal pneumonia Eur. Respir. J., September 1, 2007; 30(3): 517 - 524. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S. Hui, S. D. Hall, M. T.V. Chan, B. K. Chow, S. S. Ng, T. Gin, and J. J.Y. Sung Exhaled Air Dispersion During Oxygen Delivery Via a Simple Oxygen Mask Chest, August 1, 2007; 132(2): 540 - 546. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Bont, E. Hak, C. E Birkhoff, A. W Hoes, and T. J. Verheij Is co-morbidity taken into account in the antibiotic management of elderly patients with acute bronchitis and COPD exacerbations? Fam. Pract., August 1, 2007; 24(4): 317 - 322. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Collini, M. Beadsworth, J. Anson, T. Neal, P. Burnham, P. Deegan, N. Beeching, and A. Miller Community-acquired pneumonia: doctors do not follow national guidelines Postgrad. Med. J., August 1, 2007; 83(982): 552 - 555. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Bont, E. Hak, A. W. Hoes, M. Schipper, F. G. Schellevis, and T. J. M. Verheij A prediction rule for elderly primary-care patients with lower respiratory tract infections Eur. Respir. J., May 1, 2007; 29(5): 969 - 975. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. P. Bhatt One More Prediction Rule: Has Anything New Been Added? Am. J. Respir. Crit. Care Med., April 1, 2007; 175(7): 743 - 743. [Full Text] [PDF]
|
|
|
|
|
|
W. S. Lim Severity assessment in community-acquired pneumonia: moving on Thorax, April 1, 2007; 62(4): 287 - 288. [Full Text] [PDF]
|
|
|
|
|
|
S. Yan Man, N. Lee, M. Ip, G. E Antonio, S. S L Chau, P. Mak, C. A Graham, M. Zhang, G. Lui, P. K S Chan, et al. Prospective comparison of three predictive rules for assessing severity of community-acquired pneumonia in Hong Kong Thorax, April 1, 2007; 62(4): 348 - 353. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Barlow, D. Nathwani, and P. Davey The CURB65 pneumonia severity score outperforms generic sepsis and early warning scores in predicting mortality in community-acquired pneumonia Thorax, March 1, 2007; 62(3): 253 - 259. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Barlow, D. Nathwani, F. Williams, S. Ogston, J. Winter, M. Jones, P. Slane, E. Myers, F. Sullivan, N. Stevens, et al. Reducing door-to-antibiotic time in community-acquired pneumonia: controlled before-and-after evaluation and cost-effectiveness analysis Thorax, January 1, 2007; 62(1): 67 - 74. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. T. Huang and D. M. Yealy Decision Rules and Pneumonia: What Are We "Predicting," and for Whom? Am. J. Respir. Crit. Care Med., December 1, 2006; 174(11): 1169 - 1170. [Full Text] [PDF]
|
|
|
|
|
|
P. P. Espana, A. Capelastegui, I. Gorordo, C. Esteban, M. Oribe, M. Ortega, A. Bilbao, and J. M. Quintana Development and Validation of a Clinical Prediction Rule for Severe Community-acquired Pneumonia Am. J. Respir. Crit. Care Med., December 1, 2006; 174(11): 1249 - 1256. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P G P Charles, P D R Johnson, M L Grayson, and K L Buising Still awaiting a useful tool for predicting severe CAP. Thorax, December 1, 2006; 61(12): 1098 - 1099. [Full Text] [PDF]
|
|
|
|
|
|
C. Spindler and A. Ortqvist Prognostic score systems and community-acquired bacteraemic pneumococcal pneumonia Eur. Respir. J., October 1, 2006; 28(4): 816 - 823. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. C. Dean, K. A. Bateman, S. M. Donnelly, M. P. Silver, G. L. Snow, and D. Hale Improved clinical outcomes with utilization of a community-acquired pneumonia guideline. Chest, September 1, 2006; 130(3): 794 - 799. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Torres and R. Menendez Mortality in COPD patients with community-acquired pneumonia: who is the third partner? Eur. Respir. J., August 1, 2006; 28(2): 262 - 263. [Full Text] [PDF]
|
|
|
|
|
|
M. I. Restrepo, E. M. Mortensen, J. A. Pugh, and A. Anzueto COPD is associated with increased mortality in patients with community-acquired pneumonia Eur. Respir. J., August 1, 2006; 28(2): 346 - 351. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Ewig and M. A. Woodhead From the authors Eur. Respir. J., July 1, 2006; 28(1): 254 - 255. [Full Text] [PDF]
|
|
|
|
|
|
A. F. Shorr, M. Bodi, A. Rodriguez, J. Sole-Violan, J. Garnacho-Montero, J. Rello, and for the CAPUCI Study Investigators Impact of antibiotic guideline compliance on duration of mechanical ventilation in critically ill patients with community-acquired pneumonia. Chest, July 1, 2006; 130(1): 93 - 100. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. V. Kamath, P. K. Myint, S. L. Vowler, and B. D. W. Harrison Is it time to rethink the urea criterion in CURB-65? Eur. Respir. J., June 1, 2006; 27(6): 1321 - 1322. [Full Text] [PDF]
|
|
|
|
|
|
Z. Hoare and W. S. Lim Pneumonia: update on diagnosis and management. BMJ, May 6, 2006; 332(7549): 1077 - 1079. [Full Text] [PDF]
|
|
|
|
 |
|
 P. K. Myint, A. V. Kamath, S. L. Vowler, D. N. Maisey, and B. D. W. Harrison Severity assessment criteria recommended by the British Thoracic Society (BTS) for community-acquired pneumonia (CAP) and older patients. Should SOAR (systolic blood pressure, oxygenation, age and respiratory rate) criteria be used in older people? A compilation study of two prospective cohorts. Age Ageing, May 1, 2006; 35(3): 286 - 291. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Vestbo Clinical Assessment, Staging, and Epidemiology of Chronic Obstructive Pulmonary Disease Exacerbations Proceedings of the ATS, May 1, 2006; 3(3): 252 - 256. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K L Buising, K A Thursky, J F Black, L MacGregor, A C Street, M P Kennedy, and G V Brown A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia Thorax, May 1, 2006; 61(5): 419 - 424. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Challen, J. Bright, A. Bentley, and D. Walter Physiological-social scoring is important in pandemic flu. BMJ, March 18, 2006; 332(7542): 669 - 669. [Full Text]
|
|
|
|
|
|
S. Ewig, A. Torres, and M. Woodhead Assessment of pneumonia severity: a European perspective Eur. Respir. J., January 1, 2006; 27(1): 6 - 8. [Full Text] [PDF]
|
|
|
|
|
|
M. S. Niederman, C. Feldman, and G. A. Richards Combining information from prognostic scoring tools for CAP: an American view on how to get the best of all worlds. Eur. Respir. J., January 1, 2006; 27(1): 9 - 11. [Full Text] [PDF]
|
|
|
|
|
|
A. Capelastegui, P. P. Espana, J. M. Quintana, I. Areitio, I. Gorordo, M. Egurrola, and A. Bilbao Validation of a predictive rule for the management of community-acquired pneumonia Eur. Respir. J., January 1, 2006; 27(1): 151 - 157. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Falguera, R. Pifarre, A. Martin, A. Sheikh, and A. Moreno Etiology and Outcome of Community-Acquired Pneumonia in Patients With Diabetes Mellitus Chest, November 1, 2005; 128(5): 3233 - 3239. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G Barlow and D Nathwani Is antibiotic resistance a problem? A practical guide for hospital clinicians Postgrad. Med. J., November 1, 2005; 81(961): 680 - 692. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Menendez, A. Torres, R. Zalacain, J. Aspa, J. J. Martin-Villasclaras, L. Borderias, J. M. Benitez-Moya, J. Ruiz-Manzano, F. R. de Castro, J. Blanquer, et al. Guidelines for the Treatment of Community-acquired Pneumonia: Predictors of Adherence and Outcome Am. J. Respir. Crit. Care Med., September 15, 2005; 172(6): 757 - 762. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Weiss and G. S. Tillotson The Controversy of Combination vs Monotherapy in the Treatment of Hospitalized Community-Acquired Pneumonia Chest, August 1, 2005; 128(2): 940 - 946. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Ramsdell, G. L. Narsavage, J. B. Fink, and for the American College of Chest Physicians' Home Management of Community-Acquired Pneumonia in the Home: An American College of Chest Physicians Clinical Position Statement Chest, May 1, 2005; 127(5): 1752 - 1763. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Yamada, H Kubo, K Ishizawa, S Kobayashi, M Shinkawa, and H Sasaki Increased circulating endothelial progenitor cells in patients with bacterial pneumonia: evidence that bone marrow derived cells contribute to lung repair Thorax, May 1, 2005; 60(5): 410 - 413. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D Mills, M. R Oehley, and B. Arrol Effectiveness of {beta} lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia: meta-analysis BMJ, February 26, 2005; 330(7489): 456. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W-S Lim Identifying failure of empirical treatment for pneumonia: vigilance and common sense Thorax, November 1, 2004; 59(11): 918 - 919. [Full Text] [PDF]
|
|
|
|
|
|
J T Macfarlane and D Boldy 2004 update of BTS pneumonia guidelines: what's new? Thorax, May 1, 2004; 59(5): 364 - 366. [Full Text] [PDF]
|
|
|
|
 |
|
 Other articles noted Evid. Based Med., January 1, 2004; 9(1): 31 - 32. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
