CRB-65 predicts death from community-acquired pneumonia

BAUER, T. T.
EWIG, S.
MARRE, R.
SUTTORP, N.
WELTE, T.

¹HELIOS Clinic Emil v. Behring, Respiratory Diseases Clinic Heckeshorn, Berlin, Germany
²Augusta-Krankenanstalt, Klinik für Pneumologie, Beatmungsmedizin und Infektiologie, Germany
³Department of Medical Microbiology and Hygiene, University of Ulm, Ulm, Germany
⁴Department of Internal Medicine/Infectious Diseases, Charité, Humboldt-University – Medicine Berlin, Berlin, Germany
⁵Department of Pneumology, Hannover Medical School, University of Hannover, Hannover, Germany

Correspondence: Prof. Dr Tobias Welte, Department of Pneumology, University of Hannover, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany. (fax: +49-511-5323353; e-mail: [email protected]).

Journal of Internal Medicine 260(1):p 93-101, July 2006.

Objective

The study was performed to validate the CURB, CRB and CRB-65 scores for the prediction of death from community-acquired pneumonia (CAP) in both the hospital and out-patient setting.

Design

Data were derived from a large multi-centre prospective study initiated by the German competence network for community-acquired pneumonia (CAPNETZ) which started in March 2003 and were censored for this analysis in October 2004.

Setting

Out- and in-hospital patients in 670 private practices and 10 clinical centres.

Subjects

Analysis was done for n = 1343 patients (n = 208 out-patients and n = 1135 hospitalized) with all data sets completed for the calculation of CURB and repeated for n = 1967 patients (n = 482 out-patients and n = 1485 hospitalized) with complete data sets for CRB and CRB-65.

Intervention

None. 30-day mortality from CAP was determined by personal contacts or a structured interview.

Results

Overall 30-day mortality was 4.3% (0.6% in out-patients and 5.5% in hospitalized patients, P < 0.0001). Overall, the CURB, CRB and CRB-65 scores provided comparable predictions for death from CAP as determined by receiver–operator-characteristics (ROC) curves. However, in hospitalized patients, CRB misclassified 26% of deaths as low risk patients. Availability of the CRB-65 score (90%) was far superior to that of CURB (65%), due to missing blood urea nitrogen values (P < 0.001).

Conclusions

Both the CURB and CRB-65 scores can be used in the hospital and out-patients setting to assess pneumonia severity and the risk of death. Given that the CRB-65 is easier to handle, we favour the use of CRB-65 where blood urea nitrogen is unavailable.

CRB-65 predicts death from community-acquired pneumonia*