Figures
- Fig. 1—
Receiver-operating characteristic curves of predicting 30-day mortality according to pneumonia severity index (PSI), CURB-65 and CRB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and age ≥65 yrs; see text for exact definition) score. ———: PSI (area under the curve (AUC) 0.888, 95% confidence interval (CI) 0.864–0.912); – – – –: CURB-65 (AUC 0.870, 95% CI 0.844–0.895); -------: CRB-65 (AUC 0.864, 95% CI 0.835–0.892).
Tables
- Table 1—
Characteristics of patients
Characteristics Inpatients Outpatients All patients Subjects n 1100 676 1776 Male 715 (65) 409 (60.5) 1124 (63.3) Age yrs 71.1±15.9 46.8±17.9 61.8±20.5 Age ≥65 yrs 823 (74.8) 150 (22.2) 973 (54.8) Nursing home resident 99 (9.0) 3 (0.4) 102 (5.7) Prior antibiotics 210 (19.8) 126 (19.8) 336 (19.8) Co-morbid illnesses Neoplastic disease 70 (6.4) 2 (0.3) 72 (4.1) Liver disease 55 (5.0) 7 (1.0) 62 (3.5) Congestive heart failure 90 (8.2) 11 (1.6) 101 (5.7) Cerebrovascular disease 135 (12.3) 9 (1.3) 144 (8.1) Renal disease 106 (9.6) 9 (1.3) 115 (6.5) PSI risk class# I 113 (10.3) 407 (60.2) 520 (29.3) II 111 (10.1) 176 (26) 287 (16.2) III 260 (23.6) 78 (11.5) 338 (19) IV 423 (38.5) 15 (2.2) 438 (24.7) V 193 (17.6) 0 (0) 193 (10.9) PSI 98.8±35.5 46.6±21.2 78.9±39.9 Data presented as n (%) or mean±sd. #: severity of illness was assessed using the Pneumonia Severity Index (PSI) 6. Class I patients have the lowest severity and mortality risk, and class V the highest severity and mortality risk.
- Table 2—
Mortality, use of mechanical ventilation, and hospital admission according to CURB-65 and CRB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and age ≥65 yrs) score
Patients n 30-day mortality Mechanical ventilation# Admission to hospital CURB-65 score 0 629 0 (0) 0 (0) 153 (24.3) 1 377 4 (1.1) 2 (0.5) 247 (65.5) 2 474 36 (7.6) 9 (1.9) 406 (85.7) 3 224 47 (21) 4 (2) 222 (99.1) 4 62 26 (41.9) 2 (4.2) 62 (100) 5 10 6 (60) 1 (11.1) 10 (100) Total 1776 119 (6.7) 18 (1) 1100 (61.9) p-value <0.001 <0.001 <0.001 CRB-65 score 0 716 0 (0) 1 (0.1) 201 (28.1) 1 686 28 (4.1) 8 (1.2) 529 (77.1) 2 294 55 (18.7) 6 (2.2) 290 (98.6) 3 69 30 (43.5) 2 (3.9) 69 (100) 4 11 6 (54.6) 1 (10) 11 (100) Total 1776 119 (6.7) 18 (1) 1100 (61.9) p-value <0.001 <0.001 <0.001 Data presented as n (%) and included all patients (both inpatients and outpatients). #: deaths from pneumonia as an expected terminal event of a chronic disabling illness excluded.
- Table 3—
Additional criteria for admission decision in patients with CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and age ≥65 yrs) scores of 0, 1, and 2
Criteria CURB-65 score Total p-value 0 1 2 Outpatients and inpatients Patients n 629 377 474 1480 Coexisting disease 3.5 22.8 34.2 18.2 <0.001 Pa,O2 <60 mmHg 7.5 28.7 42.4 24.1 <0.001 pH <7.35 1.8 1.1 4.6 2.5 <0.01 Bilateral or multilobe radiographic involvement 9.2 14.1 21.1 14.3 <0.001 Pleural effusion 6 8.2 11 8.2 0.01 One of previous criteria 18.1 35.5 39.5 29.4 <0.001 Two or more criteria 4.6 18 32.9 17.1 <0.001 Inpatients Patients n 153 247 406 806 Coexisting disease 9.2 30 36.2 29.2 <0.001 Pa,O2 <60 mmHg 22.2 40.1 47.8 40.6 <0.001 pH <7.35 3.3 0.8 5.4 3.6 <0.01 Bilateral or multilobe radiographic involvement 26.1 19.4 23.9 23 0.25 Pleural effusion 17.7 9.7 11.8 12.3 0.06 One of previous criteria 43.1 42.5 41.1 41.9 0.89 Two or more criteria 16.3 26.3 37.4 30 <0.001 Data are given as % unless otherwise indicated. Pa,O2: arterial oxygen tension. kPa = mmHg × 0.133.
- Table 4—
Distribution of CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and age ≥65 yrs) scores according to the pneumonia severity index (PSI) and subgroup 30-day mortality
CURB-65 score PSI risk class Total p-value I–III IV–V Patients n Died % Patients n Died % Patients n Died % 0–1 929 0.2 77 2.6 1006 0.4 <0.01 2 194 2.6 280 11.1 474 7.6 <0.001 >2 22 4.6 274 28.5 296 26.7 0.01 Total 1145 0.7 631 17.6 1776 6.7 <0.001 Total patients includes both inpatients and outpatients.
- Table 5—
Inpatient medical indicators by CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and age ≥65 yrs) scores
Medical indicators CURB-65 score Total p-value 0 1 2 3 4 5 Patients n 153 247 406 222 62 10 1100 Length of antibiotic therapy days# 11.6±4 10.5±2.8 10.9±3.3 10.9±3.5 11.3±3.9 9.2±5 10.9±3.4 0.07 Length of intravenous therapy mean days# 2.6±2.2 2.6±2.4 2.9±2.7 3.3±3.7 4.9±4.8 5.6±4.6 2.9±2.9 <0.001 Mortality In-hospital mortality 0 (0) 3 (1.2) 24 (5.9) 42 (18.9) 22 (35.5) 5 (50) 96 (8.7) <0.001 30-day mortality 0 (0) 4 (1.6) 35 (8.6) 47 (21.2) 26 (41.9) 6 (60) 118 (10.7) <0.001 Mortality¶ In-hospital mortality 0 (0) 3 (1.2) 16 (4.1) 23 (11.4) 10 (20.8) 4 (44.4) 56 (5.3) <0.001 30-day mortality 0 (0) 4 (1.6) 24 (6.1) 27 (13.4) 12 (25) 5 (55.6) 72 (6.8) <0.001 Admission to intensive care unit¶ 1 (0.7) 8 (3.2) 21 (5.3) 11 (5.5) 3 (6.3) 1 (11.1) 45 (4.3) 0.12 Mechanical ventilation¶ 0 (0) 2 (0.8) 9 (2.3) 4 (2) 2 (4.2) 1 (11.1) 18 (1.7) 0.04 30-day readmission 1 (0.7) 4 (1.6) 14 (3.5) 11 (5) 3 (4.8) 0 (0) 33 (3) 0.12 Length of hospital stay# Days 4.5±3.1 4.4±3 5.3±4.7) 5.9±4.9 7±6.5 7±6 5.1±4.3 <0.001 Days median 4 4 4 5 5 5 4 <0.001 ≤3 days 65 (42.5) 113 (46.3) 153 (40.1) 54 (30) 9 (22.5) 2 (40) 396 (39.4) <0.01 Data are presented as mean±sd or n (%). #: in-hospital deaths excluded. ¶: deaths from pneumonia as an expected terminal event of a chronic disabling illness excluded.
