Pflug Marc Andre, Tiutan Timothy, Wesemann Thomas, Nüllmann Harald, Heppner Hans Jürgen, Pientka Ludger, Thiem Ulrich
School of Medicine, University of Bochum, Bochum, Germany.
College of Medicine, University of Arizona, Tucson, USA.
Postgrad Med J. 2015 Feb;91(1072):77-82. doi: 10.1136/postgradmedj-2014-132802. Epub 2015 Jan 24.
The management of community-acquired pneumonia (CAP) continues to be a challenge, especially in older people. To enable better risk stratification, a variation of the severity scores CRB-65 and CURB-65, called CURB-age, has been suggested. We compared the association between risk groups as defined by the scores and 30-day mortality for a cohort of mainly older inpatients with CAP.
We retrospectively analysed data from the CAP database from the years 2005 to 2009 of a single centre in Herne, Germany. Patient characteristics, criteria values within the severity scores CURB-65, CRB-65 and CURB-age, and 30-day mortality were assessed. We compared the association between score points and score-defined risk groups and mortality. Sensitivity and specificity with corresponding 95% CIs were calculated, and receiver operating characteristic (ROC) curve analysis was performed.
Data from 559 patients were analysed (mean age 74.1 years, 55.3% male). Mortality at day 30 was 10.9%. CURB-age included more patients in the low-risk category than CRB-65 (195 vs 89), and the patient group had a lower mortality (2.6% vs 3.4%). When compared with CURB-65, CURB-age included slightly fewer patients (195 vs 214) with lower mortality (2.6% vs 4.2%). CURB-age sorted the most patients who died within 30 days into the high-risk CAP group (CURB-age, 32; CURB-65, 28; CRB-65, 9), which had the highest mortality (CURB-age, 26.4%; CURB-65, 19.4%; CRB-65, 21.4%). Advantages of CURB-age categories were depicted through ROC curve analysis (area under the curve 0.73 (95% CI 0.67 to 0.79) for CURB-age categories, 0.67 (95% CI 0.60 to 0.74) for CURB-65 categories, and 0.59 (95% CI 0.52 to 0.66) for CRB-65 categories).
In comparison with CRB-65 and CURB-65, risk stratification as defined by CURB-age showed the closest association with 30-day mortality in our sample. Further prospective studies are needed to assess the potential of CURB-age for better risk prediction, especially in older patients with CAP.
社区获得性肺炎（CAP）的管理仍然是一项挑战，尤其是在老年人中。为了实现更好的风险分层，有人提出了一种严重程度评分CRB-65和CURB-65的变体，称为CURB-age。我们比较了这些评分所定义的风险组与一组主要为老年CAP住院患者30天死亡率之间的关联。
我们回顾性分析了德国赫内一个中心2005年至2009年CAP数据库中的数据。评估了患者特征、严重程度评分CURB-65、CRB-65和CURB-age中的标准值以及30天死亡率。我们比较了评分点与评分定义的风险组和死亡率之间的关联。计算了敏感性和特异性以及相应的95%置信区间，并进行了受试者工作特征（ROC）曲线分析。
分析了559例患者的数据（平均年龄74.1岁，男性占55.3%）。30天死亡率为10.9%。与CRB-65相比，CURB-age将更多患者归入低风险类别（195例对89例），且该患者组死亡率较低（2.6%对3.4%）。与CURB-65相比，CURB-age纳入的患者略少（195例对214例），死亡率也较低（2.6%对4.2%）。CURB-age将30天内死亡的大多数患者归入高风险CAP组（CURB-age为32例；CURB-65为28例；CRB-65为9例），该组死亡率最高（CURB-age为26.4%；CURB-65为19.4%；CRB-65为21.4%）。通过ROC曲线分析描述了CURB-age类别的优势（CURB-age类别的曲线下面积为0.73（95%置信区间0.67至0.79），CURB-65类别的曲线下面积为0.67（95%置信区间0.60至0.74），CRB-65类别的曲线下面积为0.59（95%置信区间0.52至0.66））。
与CRB-65和CURB-65相比，CURB-age所定义的风险分层在我们的样本中显示出与30天死亡率的关联最为密切。需要进一步的前瞻性研究来评估CURB-age在更好地进行风险预测方面的潜力，尤其是在老年CAP患者中。
