Barlow Gavin, Nathwani Dilip, Davey Peter
Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, East Yorkshire HU16 5JQ, UK.
Thorax. 2007 Mar;62(3):253-9. doi: 10.1136/thx.2006.067371. Epub 2006 Aug 23.
The performance of CURB65 in predicting mortality in community-acquired pneumonia (CAP) has been tested in two large observational studies. However, it has not been tested against generic sepsis and early warning scores, which are increasingly being advocated for identification of high-risk patients in acute medical wards.
A retrospective analysis was performed of data prospectively collected for a CAP quality improvement study. The ability to stratify mortality and performance characteristics (sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating curve) were calculated for stratifications of CURB65, CRB65, the systemic inflammatory response syndrome (SIRS) criteria and the standardised early warning score (SEWS).
419 patients were included in the main analysis with a median age of 74 years (men = 47%). CURB65 and CRB65 stratified mortality in a more clinically useful way and had more favourable operating characteristics than SIRS or SEWS; for example, mortality in low-risk patients was 2% when defined by CURB65, but 9% when defined by SEWS and 11-17% when defined by variations of the SIRS criteria. The sensitivity, specificity, positive predictive value and negative predictive value of CURB65 was 71%, 69%, 35% and 91%, respectively, compared with 62%, 73%, 35% and 89% for the best performing version of SIRS and 52%, 67%, 27% and 86% for SEWS. CURB65 had the greatest area under the receiver operating curve (0.78 v 0.73 for CRB65, 0.68 for SIRS and 0.64 for SEWS).
CURB65 should not be supplanted by SIRS or SEWS for initial prognostic assessment in CAP. Further research to identify better generic prognostic tools is required.
在两项大型观察性研究中对CURB65预测社区获得性肺炎（CAP）死亡率的性能进行了测试。然而，尚未将其与通用脓毒症及早期预警评分进行对比测试，而这些评分在急性内科病房中越来越多地被提倡用于识别高危患者。
对为一项CAP质量改进研究前瞻性收集的数据进行回顾性分析。计算了CURB65、CRB65、全身炎症反应综合征（SIRS）标准和标准化早期预警评分（SEWS）分层的死亡率分层能力及性能特征（敏感性、特异性、阳性预测值、阴性预测值和受试者工作特征曲线下面积）。
主要分析纳入了419例患者，中位年龄74岁（男性占47%）。CURB65和CRB65在分层死亡率方面临床实用性更强，且与SIRS或SEWS相比具有更有利的操作特征；例如，根据CURB65定义，低风险患者的死亡率为2%，而根据SEWS定义为9%，根据SIRS标准的不同变体定义为11%-17%。CURB65的敏感性、特异性、阳性预测值和阴性预测值分别为71%、69%、35%和91%，而表现最佳的SIRS版本分别为62%、73%、35%和89%，SEWS分别为52%、67%、27%和86%。CURB65在受试者工作特征曲线下面积最大（CRB65为0.73，SIRS为0.68，SEWS为0.64）。
在CAP的初始预后评估中，CURB65不应被SIRS或SEWS取代。需要进一步研究以确定更好的通用预后工具。
