Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033.
Eur J Clin Microbiol Infect Dis. 2012 Dec;31(12):3281-6. doi: 10.1007/s10096-012-1693-8. Epub 2012 Jul 18.
The CURB-65 scoring system performs well at identifying patients with pneumonia who have a low risk of death. Whether it predicts mortality in community-acquired pneumonia (CAP) better than the 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) minor criteria in low-mortality-rate settings is not clear. The purpose of this study was to determine the hypothesis.A total of 1,230 adult inpatients admitted to our hospital from 2005 to 2009 for CAP were reviewed retrospectively.The hospital mortality was 1.3 %. Percentage mortality increased significantly with CURB-65 score and the increasing number of IDSA/ATS minor criteria present. The number of CURB-65 criteria or IDSA/ATS minor criteria present had significant increased odds ratios for mortality of 7.547 and 2.711, respectively. The sensitivities of a CURB-65 score of ≥ 3 and the presence of ≥ 3 minor criteria in predicting mortality was 25 % and 37.5 %, which increased to 75 % and 62.5 %, while the cut-off values reduced to ≥ 2 criteria, respectively. The area under the receiver operating characteristic curve for CURB-65 was greater than the corresponding area for IDSA/ATS minor criteria in predicting hospital mortality (0.915 vs. 0.805, p = 0.0091).CURB-65 score predicted hospital mortality better than IDSA/ATS minor criteria, and a CURB-65 score of ≥ 2 or the presence of ≥ 2 minor criteria might be more valuable cut-off values for "severe" CAP in a low-mortality-rate setting.
CURB-65 评分系统在识别低死亡风险肺炎患者方面表现良好。在低死亡率环境中，它是否比 2007 年传染病学会/美国胸科学会 (IDSA/ATS) 小标准更好地预测社区获得性肺炎 (CAP) 的死亡率尚不清楚。本研究的目的是验证这一假设。
回顾性分析了 2005 年至 2009 年我院收治的 1230 例成人 CAP 住院患者。医院死亡率为 1.3%。死亡率随着 CURB-65 评分和 IDSA/ATS 小标准数量的增加而显著增加。CURB-65 标准或 IDSA/ATS 小标准的数量对死亡率的优势比分别为 7.547 和 2.711。CURB-65 评分≥3 分和存在≥3 项次要标准预测死亡率的敏感性分别为 25%和 37.5%，而特异性分别为 75%和 62.5%，而截值分别降低至≥2 项。在预测医院死亡率方面，CURB-65 的受试者工作特征曲线下面积大于 IDSA/ATS 小标准的相应面积（0.915 比 0.805，p=0.0091）。
CURB-65 评分预测医院死亡率优于 IDSA/ATS 小标准，在低死亡率环境中，CURB-65 评分≥2 分或存在≥2 项次要标准可能是“严重”CAP 的更有价值的截断值。
