The role of CURB-65 score in evolution of community-acquired pneumonia

Abstract

Introduction: Community-acquired pneumonia (CAP) is a cause of considerable morbidity and mortality in adults, leading to high rates of hospitalizations, especially in the elderly. The 6- point CURB-65 score, one point for each of: Confusion, Urea >7mmol/l, Respiratory rate >30/min, low systolic (<90 mmHg) or diastolic (<60 mmHg) Blood pressure, age >65 years, enabled patients to be stratified according to increasing risk o f mortality into different management groups. There are 3 groups: 0-1 points-low severity, these patients may be suitable for treatment at home, 2 points - moderate severity, short-stay inpatient treatment or hospital-supervised outpatient treatment, and > 3 points-high-severity, inpatient treatment, and for the patients with score 4 or 5 treatment in ICU Purpose and objectives: To assess the usefulness of the CURB-65 score in the management of CAP, and to determine the outcome in relation to the degree of severity using CURB-65. Materials and Methods: 90 patients admitted to the Institute of Phthisiopneumology “Chiril Draganiuc” with CAP were studied retrospectively. The study group was formed by 43 (47.8%) women and 47 (52.2%) men. The average age was 58.89 ± 18.45 (95 % Cl: 55.02 - 58.99) years. The study is based on the analysis of the CURB-65 score to predict the mortality and the need for hospital or ICU admission of patients with CAP, correlated with local criteria for hospital admission and intensive care unit (ICU) admission. Results: 17 patients (18.9%) were with CURB-65 score 0, 30(33.3%) with score 1, 31 (34.4%) with score 2, 8(8.9%) with score 3, 3(3.3%) with score 4 and 1(1.1%) with score 5. The ICU admission rate, based on presence of 2 or more criteria for ICU admission from the national guideline for CAP was 30% (27 patients), 6 of whom (22.2 %) required mechanical ventilation. 7 patients (7.8%) died, one of them had the CURB-65 score of 2, 3 - score 3, 2 - score 4, and 1 - score 5. Conclusion: Use of CURB-65 score alone in management of patients with CAP may underestimate the real severity of illness - only 43(47.8%) of admitted patients have CURB-65 >2, which is the criteria for hospital admission. Based on CURB-65 >3, high-severity pneumonia was in 12 of cases, which represents only 44% of patients with high-severity pneumonia defined by using criteria (2 or more) for ICU admission from the national guideline for CAP. According to this, clinical judgment is essential when deciding on the management of all patients with CAP.