Assessment of oxygenation and comorbidities improves outcome prediction in patients with community-acquired pneumonia with a low CRB-65 score

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • CAPNETZ-Studiengruppe - (Autor:in)
  • Medizinische Klinik und Poliklinik I
  • Division of Pulmonology
  • Universitätsklinikum Carl Gustav Carus Dresden
  • Thoraxzentrum Ruhrgebiet
  • Klinikum Ernst von Bergmann gGmbH
  • CAPNETZ STIFTUNG
  • Charité – Universitätsmedizin Berlin

Abstract

BACKGROUND: Addition of assessment of comorbid diseases ('D') and oxygen saturation ('S') to the CRB-65 score has been recommended to improve its accuracy for risk stratification in community-acquired pneumonia (CAP). The aim of this study was to validate the resulting DS-CRB-65 score in a large cohort of patients with CAP.

METHODS: A total of 4432 patients prospectively enrolled in the CAPNETZ cohort were included in this study. Predefined end points were 28-day mortality, requirement for mechanical ventilation or vasopressors (MV/VS) and requirement for MV/VS or intensive care unit admission (MV/VS/ICU). Receiver operating characteristic curve analysis was used to determine the accuracy of the CRB-65 score and the addition of D (extra-pulmonary comorbidities) and S (oxygen saturation <90% or partial pressure of oxygen <8 kPa). Binary logistic regression and the method of Hanley and McNeil were used to compare the criteria.

RESULTS: The mortality rate was 4.0%, and 4.2% of patients required MV/VS and 6.6% required MV/VS/ICU. After multivariate analysis, D and S independently were added to the CRB-65 criteria for mortality prediction, but only S improved prediction of MV/VS and MV/VS/ICU (P < 0.001 for all). The area under the curve of the CRB-65 score was significantly improved by adding D and S for all end points (P < 0.02). Amongst patients who died or required MV/VS despite a CRB-65 score of 0, 64-80% would have been identified by the DS-CRB-65 score.

CONCLUSIONS: The addition of assessment of oxygenation and comorbidities significantly improved the prognostic accuracy of the CRB-65 score. Consequently, the DS-CRB-65 score may have a useful role in risk stratification algorithms for CAP.

Details

OriginalspracheEnglisch
Seiten (von - bis)193-202
Seitenumfang10
FachzeitschriftJournal of internal medicine
Jahrgang278
Ausgabenummer2
PublikationsstatusVeröffentlicht - Aug. 2015
Peer-Review-StatusJa

Externe IDs

PubMed 25597400
Scopus 84923103769
ORCID /0000-0001-6022-6827/work/142659557

Schlagworte

Schlagwörter

  • Adolescent, Adult, Aged, Aged, 80 and over, Community-Acquired Infections/diagnosis, Comorbidity/trends, Female, Follow-Up Studies, Germany/epidemiology, Hospitalization, Humans, Male, Middle Aged, Oxygen Consumption, Pneumonia/diagnosis, Prognosis, Prospective Studies, ROC Curve, Risk Assessment, Severity of Illness Index, Survival Rate/trends, Young Adult