Performance of the CORB (Confusion, Oxygenation, Respiratory Rate, and Blood Pressure) Scale for the Prediction of Clinical Outcomes in Pneumonia.

BACKGROUND

Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality due to misdiagnosis and inappropriate treatment approaches.

OBJECTIVE

To assess the performance of the CORB score in subjects with CAP for predicting in-hospital mortality, death within 30 days of admission, and requirement for invasive mechanical ventilation (IMV) and vasopressor support.

METHODS

A retrospective, cohort study with diagnostic test analysis of CORB and CURB-65 scores in subjects with CAP according to ATS criteria was undertaken. An alternative CORB score was estimated by replacing SpO ≤90% by the SpO/FiO ratio. Crude and adjusted odd ratios (AOR) were calculated for each variable. The area under the receiver operating characteristics curve (AUROC) was constructed for each score, and outcomes were analyzed. AUROCs were compared with the DeLong test, considering a value <0,05 statistically significant.

RESULTS

From 1,811 subjects who entered the analysis, 15.1% (273/1,811) died in hospital, 8.78% required IMV (159/1,811), and 9.77% (177/1,811) needed vasopressor support. CORB had an AUROC of 0,660 (95% CI: 0,623-0,697) for in-hospital mortality; an AUROC of 0,657 (95% CI: 0,621-0,692) for 30-day mortality; an AUROC of 0,637 (CI 95%: 0,589-0,685) for IMV requirement; and an AUROC of 0,635 (95% CI: 0,589-0,681) for vasopressor support. CORB performance increases when the SpO/FiO ratio <300 is used as oxygenation criterion in the prediction of requirement for IMV and vasopressor support, with AUROC of 0,700 (95% CI: 0,654-0,746; < 0.001) and AUROC of 0,702 (95% CI: 0,66-0,745; < 0.001), respectively. CURB-65 score presents an in-hospital mortality AUROC of 0,727 (95% CI: 0,695-0,759) and 30-day mortality AUROC of 0,726 (95% CI: 0,695-0,756).

CONCLUSIONS

CORB score has a good performance in predicting the need for IMV and vasopressor support in CAP patients. This performance improves when the SpO/FiO ratio <300 is used instead of the SpO2 ≤90% as the oxygenation parameter. CURB-65 score is superior in the prediction of mortality.