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A Journal on Diseases of the Respiratory System

Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index




Minerva Pneumologica 2005 September;44(3):85-92

language: Italian

Predictive rules for prognosis in community-acquired pneumonia

Putinati S., Ballerin L., Zabini F., Piattella M., Ritrovato L., Simoni M., Potena A.


Aim. Community-acquired pneumonia (CAP) represents an important public burden. Pneumonia severity index (PSI), Confusion, Urea nitrogen, Respiratory rate, Blood pressure (CURB) and CURB-65 (CURB-age) scores are 3 validated prognostic rules for identifying the patients at low-risk for mortality, who might be treated at home (out-patients), thus reducing public costs. The aim of this study was to compare the performance of PSI, CURB, and CURB-65 for predicting thirty-day mortality, among hospitalized patients with CAP.
Methods. Three hundred and six patients (mean age 72 years, 52% males) have been classified into both PSI risk classes (I-V, low-risk Results. CURB-65 score < 2 classified an higher proportion of low-risk patients (45.8%, 140/306) than PSI < IV (40.2%, 123/306), or CURB score < 1 (39.2%, 120/306). Among the patients classified at low-risk by PSI (1.8%, 1/123) there was a lower prevalence of mortality, when compared to low-risk patients according to CURB (3.3%, 4/120) or CURB-65 (3.5%, 5/140). However, such differences were not statistically significant. At comparable cut-points, PSI showed higher sensitivity and negative predictive values, but lower specificity, than either CURB or CURB-65 scores. Prognostic accuracy of the 3 rules was similar, in so far as the areas under the receiver operating curve did not significantly differ (0.83 for PSI, about 0.78 for CURB scores).
Conclusion. The results seem to indicate that CURB scores, for their higher specificity, along with their easier computation, might be more preferable than PSI scoring system for defining outpatients.

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