Community acquired pneumonia (CAP) is a leading cause of admission and mortality. CURB-65 is the traditional risk stratification score. This can under predict severity in the young and does not predict requirement for higher level care. Combining CURB-65 with lactate can improve this.1 We reviewed CAP admissions over one month to determine if lactate improved risk stratification.
CAP patients were identified via coding. Authors reviewed admission chest radiographs and reports to confirm CAP. CURB-65 score was calculated from the electronic patient record (EPR), and electronic discharge letters. Lactate values were identified from Emergency Department documents scanned into EPR. Accuracy of coding and mortality in a wrongly coded group was a secondary measurement. A LAC–CURB score of low, medium or high was allocated.
138 episodes of CAP were coded. 89 were confirmed CAP. Mean age was 71.2 yrs (21–98). CURB-65 score was available in 87. 45 scored CURB-65 0–1 with 2 deaths (4.4%). 24 were CURB-65 2, with 8 deaths (33.3%) and 6 of 18 CURB-65 3–5 patients died (33.3%).
A lactate value was available in 52. 16 had a low LAC-CURB score with 0 deaths and 1 ICU admission. 23 had a medium score, with 3 deaths (13%) and 2 ICU admissions. 13 had a high LAC-CURB score, with 4 deaths (31%) and 1 ICU admission. In 4 patients it was the lactate value that increased the risk category from a medium CURB-65 score to a High LAC-CURB score. All 4 were admitted to ICU, with 2 deaths. Length of stay did not alter significantly with CURB-65 or LAC-CURB, but increased with severity. Diagnoses were available in 45 of the 49 patients coded incorrectly as CAP with a 17.78% mortality rate, identical to the CAP group.
Mortality was higher for medium and high CURB-65 patients, but a difference between them was only seen when the LAC-CURB score was applied. A high lactate identified patients in the medium CURB-65 group who died or required higher level care. Patients wrongly coded as CAP also have a high mortality.
Chen YX. Thorax 2015;70(5).