Validity of pneumonia severity index/pneumonia outcome research trial and Curb-65 severity scoring systems in community acquired pneumonia in Indian setting

Abstract

Background: The symptoms of CAP begin outside the hospital or within 48 hours of admission into the hospital in patients who has not resided in a health care facility for at least 14 days before the onset of the symptoms. Pneumonia severity index (PSI) and the CURB-65 rule for CAP have been developed to identify the relevant prognostic factors might be useful for early identification of patients at high risk requiring intensive care treatment. This study was conducted to determine prognostic factors associated with mortality in and to test the validity of PSI/PORT (pneumonia outcome research trial) and CURB-65 severity scoring systems in community acquired pneumonia (CAP) in Indian setting. Methods: Complete detailed clinical history was taken from 150 patients suspected of community acquired pneumonia patients and they were subjected to thorough physical examination, including X rays, ECG blood tests for various parameters. PSI and CURB-65 scores were taken for all the patients. Results: Maximum no. of patients, i.e.33.33% were in the age group of 60-69. Of 150 patients, 16 died accounting for a mortality rate of 10.7%. This group included 12 (8%) patients who died in hospitals and four (2.67%) who died within 30 days of discharge. All 16 patients (100%) in death group were of PSI risk class ≥IV. Mortality in PSI class I to III was 0% in class IV 14.04% and Class V 34.78%. Mortality in CURB-65 risk class 0 to II was 0%, in risk class III it was 9.52%, 47.82% in Class IV and 50% in Class V. Conclusions: PSI and CURB-65 have excellent sensitivity for predicting death but low specificity albeit specificity of CURB-65 was better than that of PSI. Because of its simplicity and ease of use, in addition to higher specificity, CURB-65 may be better suited than PSI as a severity scoring system in CAP in developing countries with limited resources.