Volume 17 Supplement 3

Seventh International Symposium on Intensive Care and Emergency Medicine for Latin America

Open Access

Comparison of CURB-65 and CRB-65 as predictors of death in community-acquired pneumonia in adults admitted to an ICU

  • AR Santana1,
  • FF Amorim1,
  • FB Soares1,
  • LG de Souza Godoy1,
  • L de Jesus Almeida1,
  • TA Rodrigues1,
  • GM de Andrade Filho1,
  • TA Silva1,
  • OG da Silva Neto1,
  • PHG Rocha1,
  • PN FerreiraJr1,
  • APP Amorim1,
  • E Bastos de Moura1,
  • JA de Araújo Neto1 and
  • M de Oliveira Maia1
Critical Care201317(Suppl 3):P39

https://doi.org/10.1186/cc12655

Published: 19 June 2013

Introduction

Community-acquired pneumonia is one of the most common causes of sepsis and ICU admissions. Patients with CAP who demand critical care had mortality rates of 25 to 50%. Thereby, the assessment of the severity is essential to guide the treatment. There are several severity scores for CAP and some of the most acknowledged are CURB-65 and CRB-65. The objective of this study was to evaluate the accuracy of CURB-65 and CRB-65 as predictors of death in patients with community-acquired pneumonia.

Methods

A prospective study during 6 months was conducted with patients diagnosed with CAP admitted to the ICU of the Hospital Santa Luzia, Brasília, DF, Brazil. Patients were stratified according to CURB-65 (0 to 5) and CRB-65 (0 to 4) and their risk categorized as: low (CURB-65: 0 to 1 and CRB-65: 0), moderate (CURB-65: 2 and CRB-65: 1 to 2) and high (CURB-65: 3 to 5 and CRB-65: 3 to 4). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio positive (LR+), and likelihood ratio negative (LR-) were calculated. Validity and reliability were assessed with the Spearman correlation coefficient. Patients with chronic kidney failure and those submitted to mechanical ventilation at the time of admission were excluded.

Results

A total of 62 patients were included. Twenty-seven with low risk, 24 with moderate risk and 11 with high risk according to CURB65 and their mortality rates were 7.4%, 8.3% and 54.5%, respectively. According to CRB-65, 11 were low risk, 44 moderate risk and seven had high risk. The mortality on CRB-65 stratification was 0%, 15.9% and 42.9% for low, moderate and high risks, respectively. When we gathered moderate and high risks, CRB-65 was more sensitive (1.00 vs. 0.80) and had better LR- (0.00 vs. 0.41), and NPV (1.00 vs. 0.92). CURB-65 had better specificity (0.48 vs. 0.21), LR+ (1.54 vs. 1.26), and PPV (0.23 vs. 0.20). The receiver operating characteristic curves of CURB-65 and CRB65 had areas of 0.758 and 0.686, respectively. The Spearman correlation coefficient was 0.612 (P = 0.00). See Figure 1.
Figure 1

abstract

Conclusion

CURB-65 and CRB-65 had a high correlation. CRB-65 was more sensitive as a predictor of death as well as a guidance for hospitalization. Moreover, CRB-65 is a more practical score since it does not use laboratorial variables.

Authors’ Affiliations

(1)
Unidade de Terapia Intensiva Adulto do Hospital Santa Luzia

References

  1. Ewig S, de Roux A, Bauer T, et al.: Validation of predictive rules and indices of severity for community acquired pneumonia. Thorax 2004, 59: 421-427. 10.1136/thx.2003.008110PubMed CentralView ArticlePubMedGoogle Scholar
  2. Correa RA, et al.: Brazilian guidelines for community-acquired pneumonia in immunocompetent adults-2009. J Bras Pneumol 2009, 35: 574-601. 10.1590/S1806-37132009000600011View ArticleGoogle Scholar

Copyright

© Santana et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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