Validation of a predictive rule for the management of community-acquired pneumonia

Service of Pneumology, Hospital de Galdakao, E-48960 Galdakao, Bizkaia, Spain.
European Respiratory Journal (Impact Factor: 7.13). 01/2006; 27(1):151-7. DOI: 10.1183/09031936.06.00062505
Source: PubMed

ABSTRACT The CURB-65 score (Confusion, Urea > 7 mmol x L(-1), Respiratory rate > or = 30 x min(-1), low Blood pressure, and age > or = 65 yrs) has been proposed as a tool for augmenting clinical judgement for stratifying patients with community-acquired pneumonia (CAP) into different management groups. The six-point CURB-65 score was retrospectively applied in a prospective, consecutive cohort of adult patients with a diagnosis of CAP seen in the emergency department of a 400-bed teaching hospital from March 1, 2000 to February 29, 2004. A total of 1,100 inpatients and 676 outpatients were included. The 30-day mortality rate in the entire cohort increased directly with increasing CURB-65 score: 0, 1.1, 7.6, 21, 41.9 and 60% for CURB-65 scores of 0, 1, 2, 3, 4, and 5, respectively. The score was also significantly associated with the need for mechanical ventilation and rate of hospital admission in the entire cohort, and with duration of hospital stay among inpatients. The CURB-65 score (Confusion, Urea > 7 mmol x L(-1), Respiratory rate > or = 30 x min(-1), low Blood pressure, and age > or = 65 yrs), and a simpler CRB-65 score that omits the blood urea measurement, helps classify patients with community-acquired pneumonia into different groups according to the mortality risk and significantly correlates with community-acquired pneumonia management key points. The new score can also be used as a severity adjustment measure.

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    ABSTRACT: Background. The aim of this study was to investigate differential changes in plasma levels of stromal-cell-derived factor-1 (SDF-1) before and after antibiotic treatment in patients with community-acquired pneumonia (CAP) and observe the association between the severity of CAP and the plasma SDF-1 level. Methods. We gathered blood specimens from 61 adult CAP patients before and after antibiotic treatment and from 60 healthy controls to measure the plasma concentrations of SDF-1 by using an enzyme-linked immunosorbent assay. Results. The plasma SDF-1 concentration was elevated significantly in patients with CAP before receiving treatment compared with the controls and decreased significantly after the patients received treatment. Leukocyte (WBC) and neutrophil counts and C-reactive protein (CRP) levels decreased significantly after antibiotic treatment. Moreover, differences in the plasma concentration of SDF-1 were significantly correlated with PSI, CURB-65, and APACHE II scores (r = 0.389, P = 0.002, and n = 61; r = 0.449, P < 0.001, and n = 61; and r = 0.363, P = 0.004, and n = 61, resp.). Conclusions. An elevated plasma SDF-1 concentration can be used as a biological marker for the early diagnosis of CAP and for the early detection of its severity.
    Disease markers 01/2014; 2014:829706. DOI:10.1155/2014/829706 · 2.17 Impact Factor
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    ABSTRACT: Community acquired pneumonia (CAP) is a major cause of morbidity, hospitalization, and mortality worldwide. Management of CAP for many patients requires rapid initiation of empirical antibiotic treatment, based on the spectrum of activity of available antimicrobial agents and evidence on local antibiotic resistance. Few data exist on the severity profile and treatment of hospitalized CAP patients in Eastern and Central Europe and the Middle East, in particular on use of moxifloxacin (Avelox(R)), which is approved in these regions.
    BMC Pulmonary Medicine 06/2014; 14(1):105. DOI:10.1186/1471-2466-14-105 · 2.49 Impact Factor
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    ABSTRACT: Background In patients with community-acquired pneumonia (CAP), short-term mortality is largely dependent on pneumonia severity, whereas long-term mortality is considered to depend on comorbidity. However, evidence indicates that severity scores used to assist management decisions at disease onset may also be associated with long-term mortality. Therefore, the objective of the study was to investigate the performance of the pneumonia severity scores CURB-65 and CRB-65 compared to the Charlson Comorbidity Index (CCI) for predicting 1-year mortality in adults discharged from hospital after inpatient treatment for CAP.Methods From a single centre, all cases of patients with CAP treated consecutively as inpatients between 2005 and 2009 and surviving at least 30 days after admission were analysed. The patients¿ vital status was obtained from the relevant local register office. CURB-65, CRB-65 and CCI were compared using receiver operating characteristics (ROC) analysis.ResultsOf 498 cases analysed, 106 (21.3%) patients died within 1 year. In univariate analysis, age ¿65 years, nursing home residency, hemiplegia, dementia and congestive heart failure were significantly associated with mortality. CURB-65, CRB-65 and CCI were also all associated with mortality at 1 year. ROC analysis yielded a weak, yet comparable test performance for CURB-65 (AUC and corresponding 95% confidence interval [CI] for risk categories: 0.652 [0.598-0.706]) and CCI (AUC [CI]: 0.631 [0.575-0.688]; for CRB-65 0.621 [0.565-0.677] and 0.590 [0.533-0.646]).Conclusions Neither CURB-65 or CRB-65 nor CCI allow excellent discrimination in terms of predicting longer term mortality. However, CURB-65 is significantly associated with long-term mortality and performed equally to the CCI in this respect. This fact may help to identify CAP survivors at higher risk after discharge from hospital.
    BMC Infectious Diseases 01/2015; 15(1):2. DOI:10.1186/s12879-014-0730-x · 2.56 Impact Factor

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