Validity of pneumonia severity index and CURB-65 severity scoring systems in community acquired pneumonia in an Indian setting.

Abstract

BACKGROUND: Little information is available from India regarding prognostic factors in patients with community acquired pneumonia (CAP). METHODS: Hospital-based prospective study to test the validity of pneumonia severity index (PSI) and the confusion, urea, respiratory rate, blood pressure, age over 65 years (CURB-65) risk scoring systems in patients with CAP (n=150). RESULTS: Although both CURB-65 class > or = III and PSI class > or = IV were 100% sensitive in predicting death, CURB-65 class > or = III had a higher specificity (74.6%) than PSI class > or = IV (52.2%) when used to predict death. In both PSI and CURB-65 risk scoring systems, mortality rate, need for intensive care unit (ICU) admission, prolonged need for intravenous (I.V.) antibiotics, prolonged duration of hospital stay and need for admission to ICU increased progressively with increasing scores. The PSI class > or = IV was more sensitive in predicting ICU admission than CURB-65. The duration of hospital stay was found to have a weak but significant correlation with PSI and CURB-65 criteria. Defervescence time also had a very weak but significant correlation with PSI and CURB-65 criteria. Duration of I.V. antibiotics had a moderately strong correlation with CURB-65 criteria but a weak correlation with PSI criteria. CONCLUSIONS: Both PSI and CURB-65 were found to have equal sensitivity to predict death from CAP. Specificity of CURB-65 was higher than that of PSI. However, PSI was more sensitive in predicting ICU admission than CURB-65.