RESPIRATORY INFECTION

Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study

W S Lim¹, M M van der Eerden², R Laing³, W G Boersma², N Karalus⁴, G I Town³, S A Lewis⁵, J T Macfarlane¹

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

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• Phua, J, See, K C, Chan, Y H, Widjaja, L S, Aung, N W, Ngerng, W J, Lim, T K (2009). Validation and clinical implications of the IDSA/ATS minor criteria for severe community-acquired pneumonia. Thorax 64: 598-603 [Abstract] [Full Text]  
• Cabre, M., Serra-Prat, M., Palomera, E., Almirall, J., Pallares, R., Clave, P. (2009). Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing 0: afp100v1-afp100 [Abstract] [Full Text]  
• Sadashivaiah, J.B., Carr, B. (2009). Severe community-acquired pneumonia. Contin Educ Anaesth Crit Care Pain 9: 87-91 [Full Text]  
• Singanayagam, A., Chalmers, J.D., Hill, A.T. (2009). Severity assessment in community-acquired pneumonia: a review. QJM 102: 379-388 [Abstract] [Full Text]  
• Yandiola, P. P. E., Capelastegui, A., Quintana, J., Diez, R., Gorordo, I., Bilbao, A., Zalacain, R., Menendez, R., Torres, A. (2009). Prospective Comparison of Severity Scores for Predicting Clinically Relevant Outcomes for Patients Hospitalized With Community-Acquired Pneumonia. Chest 135: 1572-1579 [Abstract] [Full Text]  
• Capelastegui, A, Espana, P P, Quintana, J M, Bilbao, A, Menendez, R, Zalacain, R, Torres, A (2009). Development of a prognostic index for 90-day mortality in patients discharged after admission to hospital for community-acquired pneumonia. Thorax 64: 496-501 [Abstract] [Full Text]  
• Lemyze, M, Salomon, S, Brown, D, Detouche, P, Collet, F (2009). What is the target?. BMJ 338: b1604-b1604 [Full Text]  
• Tessmer, A., Welte, T., Martus, P., Schnoor, M., Marre, R., Suttorp, N. (2009). Impact of intravenous {beta}-lactam/macrolide versus {beta}-lactam monotherapy on mortality in hospitalized patients with community-acquired pneumonia. J Antimicrob Chemother 63: 1025-1033 [Abstract] [Full Text]  
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• Shindo, Y., Sato, S., Maruyama, E., Ohashi, T., Ogawa, M., Hashimoto, N., Imaizumi, K., Sato, T., Hasegawa, Y. (2009). Health-Care-Associated Pneumonia Among Hospitalized Patients in a Japanese Community Hospital. Chest 135: 633-640 [Abstract] [Full Text]  
• Barker, B, Macfarlane, J, Lim, W S, Douglas, G, Macfarlane, J (2009). Local guidelines for management of adult community acquired pneumonia: a survey of UK hospitals. Thorax 64: 181-181 [Full Text]  
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• Grossman, R. F. (2009). Community-Acquired Pneumonia: Advances in Management. ACCP Pulmonary Med Brd Rev 25: 359-368 [Full Text]  
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• Lisboa, T., Blot, S., Waterer, G. W., Canalis, E., de Mendoza, D., Rodriguez, A., Rello, J., for the Community-Acquired Pneumonia Intensive Car, (2009). Radiologic Progression of Pulmonary Infiltrates Predicts a Worse Prognosis in Severe Community-Acquired Pneumonia Than Bacteremia. Chest 135: 165-172 [Abstract] [Full Text]  
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• Lisboa, T., Diaz, E., Sa-Borges, M., Socias, A., Sole-Violan, J., Rodriguez, A., Rello, J. (2008). The Ventilator-Associated Pneumonia PIRO Score: A Tool for Predicting ICU Mortality and Health-Care Resources Use in Ventilator-Associated Pneumonia. Chest 134: 1208-1216 [Abstract] [Full Text]  
• Salluh, J. I. F., Bozza, F. A., Soares, M., Verdeal, J. C. R., Castro-Faria-Neto, H. C., Lapa e Silva, J. R., Bozza, P. T. (2008). Adrenal Response in Severe Community-Acquired Pneumonia: Impact on Outcomes and Disease Severity. Chest 134: 947-954 [Abstract] [Full Text]  
• Capelastegui, A., Espana, P. P., Bilbao, A., Martinez-Vazquez, M., Gorordo, I., Oribe, M., Urrutia, I., Quintana, J. M. (2008). Pneumonia: Criteria for Patient Instability on Hospital Discharge. Chest 134: 595-600 [Abstract] [Full Text]  
• Ewig, S., Welte, T. (2008). CRB-65 for the assessment of pneumonia severity: who could ask for more?. Thorax 63: 665-666 [Full Text]  
• Chalmers, J D, Singanayagam, A, Hill, A T (2008). Systolic blood pressure is superior to other haemodynamic predictors of outcome in community acquired pneumonia. Thorax 63: 698-702 [Abstract] [Full Text]  
• Bont, J., Hak, E., Hoes, A. W., Macfarlane, J. T., Verheij, T. J. M. (2008). Predicting Death in Elderly Patients With Community-Acquired Pneumonia: A Prospective Validation Study Reevaluating the CRB-65 Severity Assessment Tool. Arch Intern Med 168: 1465-1468 [Full Text]  
• Durrington, H. J, Summers, C. (2008). Recent changes in the management of community acquired pneumonia in adults. BMJ 336: 1429-1433 [Full Text]  
• Teramoto, S., Yamamoto, H., Yamaguchi, Y., Hanaoka, Y., Ishii, M., Hibi, S., Kume, H., Ouchi, Y. (2008). Lower respiratory tract infection outcomes are predicted better by an age >80 years than by CURB-65. Eur Respir J 31: 477-478 [Full Text]  
• Kruger, S., Ewig, S., Marre, R., Papassotiriou, J., Richter, K., von Baum, H., Suttorp, N., Welte, T., on behalf of the CAPNETZ Study Group, (2008). Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 31: 349-355 [Abstract] [Full Text]  
• Kollef, K. E., Reichley, R. M., Micek, S. T., Kollef, M. H. (2008). 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 133: 363-369 [Abstract] [Full Text]  
• Jennings, L C, Anderson, T P, Beynon, K A, Chua, A, Laing, R T R, Werno, A M, Young, S A, Chambers, S T, Murdoch, D R (2008). Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax 63: 42-48 [Abstract] [Full Text]  
• Christ-Crain, M., Stolz, D., Jutla, S., Couppis, O., Muller, C., Bingisser, R., Schuetz, P., Tamm, M., Edwards, R., Muller, B., Grossman, A. B. (2007). Free and Total Cortisol Levels as Predictors of Severity and Outcome in Community-acquired Pneumonia. Am. J. Respir. Crit. Care Med. 176: 913-920 [Abstract] [Full Text]  
• Myint, P. K, Kamath, A. V, Vowler, S. L, Harrison, B. D W (2007). Simple modification of CURB-65 better identifies patients including the elderly with severe CAP. Thorax 62: 1015-1016 [Full Text]  
• Schaaf, B., Kruse, J., Rupp, J., Reinert, R. R., Droemann, D., Zabel, P., Ewig, S., Dalhoff, K. (2007). Sepsis severity predicts outcome in community-acquired pneumococcal pneumonia. Eur Respir J 30: 517-524 [Abstract] [Full Text]  
• Hui, D. S., Hall, S. D., Chan, M. T.V., Chow, B. K., Ng, S. S., Gin, T., Sung, J. J.Y. (2007). Exhaled Air Dispersion During Oxygen Delivery Via a Simple Oxygen Mask. Chest 132: 540-546 [Abstract] [Full Text]  
• Bont, J., Hak, E., Birkhoff, C. E, Hoes, A. W, Verheij, T. J. (2007). Is co-morbidity taken into account in the antibiotic management of elderly patients with acute bronchitis and COPD exacerbations?. Fam Pract 24: 317-322 [Abstract] [Full Text]  
• Collini, P., Beadsworth, M., Anson, J., Neal, T., Burnham, P., Deegan, P., Beeching, N., Miller, A. (2007). Community-acquired pneumonia: doctors do not follow national guidelines. Postgrad. Med. J. 83: 552-555 [Abstract] [Full Text]  
• Bont, J., Hak, E., Hoes, A. W., Schipper, M., Schellevis, F. G., Verheij, T. J. M. (2007). A prediction rule for elderly primary-care patients with lower respiratory tract infections. Eur Respir J 29: 969-975 [Abstract] [Full Text]  
• Bhatt, S. P. (2007). One More Prediction Rule: Has Anything New Been Added?. Am. J. Respir. Crit. Care Med. 175: 743-743 [Full Text]  
• Lim, W. S. (2007). Severity assessment in community-acquired pneumonia: moving on. Thorax 62: 287-288 [Full Text]  
• Yan Man, S., Lee, N., Ip, M., Antonio, G. E, Chau, S. S L, Mak, P., Graham, C. A, Zhang, M., Lui, G., Chan, P. K S, Ahuja, A. T, Hui, D. S, Sung, J. J Y, Rainer, T. H (2007). Prospective comparison of three predictive rules for assessing severity of community-acquired pneumonia in Hong Kong. Thorax 62: 348-353 [Abstract] [Full Text]  
• Barlow, G., Nathwani, D., Davey, P. (2007). The CURB65 pneumonia severity score outperforms generic sepsis and early warning scores in predicting mortality in community-acquired pneumonia. Thorax 62: 253-259 [Abstract] [Full Text]  
• Barlow, G., Nathwani, D., Williams, F., Ogston, S., Winter, J., Jones, M., Slane, P., Myers, E., Sullivan, F., Stevens, N., Duffey, R., Lowden, K., Davey, P. (2007). Reducing door-to-antibiotic time in community-acquired pneumonia: controlled before-and-after evaluation and cost-effectiveness analysis. Thorax 62: 67-74 [Abstract] [Full Text]  
• Huang, D. T., Yealy, D. M. (2006). Decision Rules and Pneumonia: What Are We "Predicting," and for Whom?. Am. J. Respir. Crit. Care Med. 174: 1169-1170 [Full Text]  
• Espana, P. P., Capelastegui, A., Gorordo, I., Esteban, C., Oribe, M., Ortega, M., Bilbao, A., Quintana, J. M. (2006). Development and Validation of a Clinical Prediction Rule for Severe Community-acquired Pneumonia. Am. J. Respir. Crit. Care Med. 174: 1249-1256 [Abstract] [Full Text]  
• Charles, P G P, Johnson, P D R, Grayson, M L, Buising, K L (2006). Still awaiting a useful tool for predicting severe CAP.. Thorax 61: 1098-1099 [Full Text]  
• Spindler, C., Ortqvist, A. (2006). Prognostic score systems and community-acquired bacteraemic pneumococcal pneumonia. Eur Respir J 28: 816-823 [Abstract] [Full Text]  
• Dean, N. C., Bateman, K. A., Donnelly, S. M., Silver, M. P., Snow, G. L., Hale, D. (2006). Improved clinical outcomes with utilization of a community-acquired pneumonia guideline.. Chest 130: 794-799 [Abstract] [Full Text]  
• Torres, A., Menendez, R. (2006). Mortality in COPD patients with community-acquired pneumonia: who is the third partner?. Eur Respir J 28: 262-263 [Full Text]  
• Restrepo, M. I., Mortensen, E. M., Pugh, J. A., Anzueto, A. (2006). COPD is associated with increased mortality in patients with community-acquired pneumonia. Eur Respir J 28: 346-351 [Abstract] [Full Text]  
• Ewig, S., Woodhead, M. A. (2006). From the authors. Eur Respir J 28: 254-255 [Full Text]  
• Shorr, A. F., Bodi, M., Rodriguez, A., Sole-Violan, J., Garnacho-Montero, J., Rello, J., for the CAPUCI Study Investigators, (2006). Impact of antibiotic guideline compliance on duration of mechanical ventilation in critically ill patients with community-acquired pneumonia.. Chest 130: 93-100 [Abstract] [Full Text]  
• Kamath, A. V., Myint, P. K., Vowler, S. L., Harrison, B. D. W. (2006). Is it time to rethink the urea criterion in CURB-65?. Eur Respir J 27: 1321-1322 [Full Text]  
• Hoare, Z., Lim, W. S. (2006). Pneumonia: update on diagnosis and management.. BMJ 332: 1077-1079 [Full Text]  
• Myint, P. K., Kamath, A. V., Vowler, S. L., Maisey, D. N., Harrison, B. D. W. (2006). 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 35: 286-291 [Abstract] [Full Text]  
• Vestbo, J. (2006). Clinical Assessment, Staging, and Epidemiology of Chronic Obstructive Pulmonary Disease Exacerbations. Proc Am Thorac Soc 3: 252-256 [Abstract] [Full Text]  
• Buising, K L, Thursky, K A, Black, J F, MacGregor, L, Street, A C, Kennedy, M P, Brown, G V (2006). A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia. Thorax 61: 419-424 [Abstract] [Full Text]  
• Challen, K., Bright, J., Bentley, A., Walter, D. (2006). Physiological-social scoring is important in pandemic flu.. BMJ 332: 669-669 [Full Text]  
• Ewig, S., Torres, A., Woodhead, M. (2006). Assessment of pneumonia severity: a European perspective. Eur Respir J 27: 6-8 [Full Text]  
• Niederman, M. S., Feldman, C., Richards, G. A. (2006). Combining information from prognostic scoring tools for CAP: an American view on how to get the best of all worlds.. Eur Respir J 27: 9-11 [Full Text]  
• Capelastegui, A., Espana, P. P., Quintana, J. M., Areitio, I., Gorordo, I., Egurrola, M., Bilbao, A. (2006). Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J 27: 151-157 [Abstract] [Full Text]  
• Falguera, M., Pifarre, R., Martin, A., Sheikh, A., Moreno, A. (2005). Etiology and Outcome of Community-Acquired Pneumonia in Patients With Diabetes Mellitus. Chest 128: 3233-3239 [Abstract] [Full Text]  
• Barlow, G, Nathwani, D (2005). Is antibiotic resistance a problem? A practical guide for hospital clinicians. Postgrad. Med. J. 81: 680-692 [Abstract] [Full Text]  
• Menendez, R., Torres, A., Zalacain, R., Aspa, J., Martin-Villasclaras, J. J., Borderias, L., Benitez-Moya, J. M., Ruiz-Manzano, J., de Castro, F. R., Blanquer, J., Perez, D., Puzo, C., Sanchez-Gascon, F., Gallardo, J., Alvarez, C., Molinos, L., on behalf of the NEUMOFAIL Group, (2005). Guidelines for the Treatment of Community-acquired Pneumonia: Predictors of Adherence and Outcome. Am. J. Respir. Crit. Care Med. 172: 757-762 [Abstract] [Full Text]  
• Weiss, K., Tillotson, G. S. (2005). The Controversy of Combination vs Monotherapy in the Treatment of Hospitalized Community-Acquired Pneumonia. Chest 128: 940-946 [Abstract] [Full Text]  
• Ramsdell, J., Narsavage, G. L., Fink, J. B., for the American College of Chest Physicians' Home, (2005). Management of Community-Acquired Pneumonia in the Home: An American College of Chest Physicians Clinical Position Statement. Chest 127: 1752-1763 [Abstract] [Full Text]  
• Yamada, M, Kubo, H, Ishizawa, K, Kobayashi, S, Shinkawa, M, Sasaki, H (2005). Increased circulating endothelial progenitor cells in patients with bacterial pneumonia: evidence that bone marrow derived cells contribute to lung repair. Thorax 60: 410-413 [Abstract] [Full Text]  
• Mills, G. D, Oehley, M. R, Arrol, B. (2005). Effectiveness of {beta} lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia: meta-analysis. BMJ 330: 456- [Abstract] [Full Text]  
• Lim, W-S (2004). Identifying failure of empirical treatment for pneumonia: vigilance and common sense. Thorax 59: 918-919 [Full Text]  
• Macfarlane, J T, Boldy, D (2004). 2004 update of BTS pneumonia guidelines: what's new?. Thorax 59: 364-366 [Full Text]  
• (2004). Other articles noted. Evid. Based Med. 9: 31-32 [Full Text]