Validity of Confusion, Uremia, Respiratory Rate, Blood Pressure, and Age ≥ 60 Years (CURB-60) and Confusion, Respiratory Rate, Blood Pressure, and Age ≥ 60 (CRB-60) in Determining the Prognosis of Community-Acquired Pneumonia in the Elderly

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Infectious Disease and Tuberculosis AND Pediatric Infectious Research Center, School of Medicine, Arak University of Medical Sciences, Arak, Iran

2 Associate Professor, Department of Infectious Disease and Tuberculosis AND Pediatric Infectious Research Center, School of Medicine, Arak University of Medical Sciences, Arak, Iran

3 Student of Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran

Abstract

Background: Due to high rates of mortality from pneumonia in the elderly, using a simple model for determining the prognosis of pneumonia can lead to a decrease in the mortality rate in this group. This study aimed to determine the validity of confusion, uremia, respiratory rate, blood pressure, and age ≥ 60 years (CURB-60) and confusion, respiratory rate, blood pressure, and age ≥ 60 (CRB-60) models in determining the prognosis of community-acquired pneumonia in the elderly and comparison them with models of the pneumonia severity index (PSI), CURB-65, and CRB-65.Methods: This cross-sectional study was conducted in 2013 in Arak University of Medical Sciences, Iran. Data of 141 patients with the age of 60 years and older with community-acquired pneumonia who had inclusion criteria were included in the study and analyzed. P-value < 0.05 was considered significant.Findings: The mean age of patients was 68.9 ± 7.6 with the median of 65.0 years. 76 patients (53.9%) were men and sex ratio of men/women was 1.17. 71.6% of patients were in urban areas. The most common comorbidity was cardiovascular disease (37.6%) and the most common sign and symptom were respiratory rale (92.2%), hypothermia or hyperthermia (88.7%), respectively. Sensitivity, specificity and positive predictive value of PSI and CURB-60 model for third day recovery were higher than the other models. The highest positive predictive value of intensive care unit (ICU) admission until the fourteenth day and 30-day mortality were in the models of CURB-65 and CRB-60.Conclusion: To determine the severity and prognosis of community-acquired pneumonia in the elderly, CURB-60 and CRB-60 models can be used.

Keywords

References

  1. Woodhead M, Blasi F, Ewig S, Huchon G, Ieven M, Ortqvist A, et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 2005; 26(6): 1138-80.
  2. Hak E, Bont J, Hoes AW, Verheij TJ. Prognostic factors for serious morbidity and mortality from community-acquired lower respiratory tract infections among the elderly in primary care. Fam Pract 2005; 22(4): 375-80.
  3. Kontou P, Kuti JL, Nicolau DP. Validation of the Infectious Diseases Society of America/American Thoracic Society criteria to predict severe community-acquired pneumonia caused by Streptococcus pneumoniae. Am J Emerg Med 2009; 27(8): 968-74.
  4. Flannery MT, McCool MJ. Community-acquired pneumonia guidelines and resident behavior. Am J Med 2005; 118(8): 929-30.
  5. Aleva RM, Boersma WG. Guideline 'Diagnosis and treatment of community-acquired pneumonia' from the Dutch Thoracic Society. Ned Tijdschr Geneeskd 2005; 149(45): 2501-7.
  6. Anevlavis S, Bouros D. Scoring systems in community acquired pneumonia. Pneumon 2009; 22(4): 286-9.
  7. Espana PP, Capelastegui A, Gorordo I, Esteban C, Oribe M, Ortega M, et al. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Am J Respir Crit Care Med 2006; 174(11): 1249-56.
  8. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 (Suppl 2): S27-S72.
  9. Chalmers JD, Singanayagam A, Hill AT. Predicting the need for mechanical ventilation and/or inotropic support for young adults admitted to the hospital with community-acquired pneumonia. Clin Infect Dis 2008; 47(12): 1571-4.
  10. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336(4): 243-50.
  11. Yende S, D'Angelo G, Kellum JA, Weissfeld L, Fine J, Welch RD, et al. Inflammatory markers at hospital discharge predict subsequent mortality after pneumonia and sepsis. Am J Respir Crit Care Med 2008; 177(11): 1242-7.
  12. Bauer TT, Ewig S, Marre R, Suttorp N, Welte T. CRB-65 predicts death from community-acquired pneumonia. J Intern Med 2006; 260(1): 93-101.
  13. Phua J, See KC, Chan YH, Widjaja LS, Aung NW, Ngerng WJ, et al. Validation and clinical implications of the IDSA/ATS minor criteria for severe community-acquired pneumonia. Thorax 2009; 64(7): 598-603.
  14. Bont J, Hak E, Hoes AW, Macfarlane JT, Verheij TJ. Predicting death in elderly patients with community-acquired pneumonia: a prospective validation study reevaluating the CRB-65 severity assessment tool. Arch Intern Med 2008; 168(13): 1465-8.
  15. Donowitz GR, Mandell GL. Acute pneumonia. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Churchill Livingstone; 2009.
  16. Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrison's principles of internal medicine. 18th ed. New York, NY: McGraw-Hill; 2011.
  17. Community-acquired pneumonia in adults in British hospitals in 1982-1983: a survey of aetiology, mortality, prognostic factors and outcome. The British Thoracic Society and the Public Health Laboratory Service. Q J Med 1987; 62(239): 195-220.
  18. Macfarlane JT. Adverse prognostic factors in pneumonia. Thorax 1983; 38(3): 231.
  19. Neill AM, Martin IR, Weir R, Anderson R, Chereshsky A, Epton MJ, et al. Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. Thorax 1996; 51(10): 1010-6.
  20. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58(5): 377-82.
  21. BTS Guidelines for the Management of Community Acquired Pneumonia in Adults. Thorax 2001; 56(Suppl 4): IV1-64.
  22. Lim WS, Lewis S, Macfarlane JT. Severity prediction rules in community acquired pneumonia: a validation study. Thorax 2000; 55(3): 219-23.
  23. Ewig S, de RA, Bauer T, Garcia E, Mensa J, Niederman M, et al. Validation of predictive rules and indices of severity for community acquired pneumonia. Thorax 2004; 59(5): 421-7.
  24. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336(4): 243-50.
  25. Ewig S, Kleinfeld T, Bauer T, Seifert K, Schafer H, Goke N. Comparative validation of prognostic rules for community-acquired pneumonia in an elderly population. Eur Respir J 1999; 14(2): 370-5.
  26. Roson B, Carratala J, Dorca J, Casanova A, Manresa F, Gudiol F. Etiology, reasons for hospitalization, risk classes, and outcomes of community-acquired pneumonia in patients hospitalized on the basis of conventional admission criteria. Clin Infect Dis 2001; 33(2): 158-65.
  27. Mortensen EM, Kapoor WN, Chang CC, Fine MJ. Assessment of mortality after long-term follow-up of patients with community-acquired pneumonia. Clin Infect Dis 2003; 37(12): 1617-24.
  28. Emami Naini S, Emami Naini A, Shirani K, Mirzadeh F, Bagheri A. Assessment of pneumonia severity index in patients with community-acquired pneumonia admitted to Alzahra Hospital, Isfahan, Iran. J Isfahan Med Sch 2012; 30(182); 336-43. [In Persian].
  29. Capelastegui A, Espana PP, Quintana JM, Areitio I, Gorordo I, Egurrola M, et al. Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J 2006; 27(1): 151-7.
  30. Aujesky D, Auble TE, Yealy DM, Stone RA, Obrosky DS, Meehan TP, et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med 2005; 118(4): 384-92.
  31. Man SY, Lee N, Ip M, Antonio GE, Chau SS, Mak P, et al. Prospective comparison of three predictive rules for assessing severity of community-acquired pneumonia in Hong Kong. Thorax 2007; 62(4): 348-53.
  32. Loh LC, Khoo SK, Quah SY, Visvalingam V, Radhakrishnan A, Vijayasingham P, et al. Adult community-acquired pneumonia in Malaysia: prediction of mortality from severity assessment on admission. Respirology 2004; 9(3): 379-86.
  33. Buising KL, Thursky KA, Black JF, MacGregor L, Street AC, Kennedy MP, et al. A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia. Thorax 2006; 61(5): 419-24.
Journal of Isfahan Medical School
Volume 32, Issue 275 - Serial Number 275
January and February 2014
Pages 149-159

Files

History

  • Receive Date: 27 December 2013
  • Revise Date: 26 May 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics