Andrew Morris, MD
In patients with community-acquired pneumonia (CAP), do CURB65, CRB65, and Pneumonia Severity Index (PSI) differ for predicting mortality?
Included studies calculated CURB65, CRB65, or PSI scores using data from consecutive patients with radiographically confirmed CAP and assessed mortality as an outcome. Pooled outcomes included sensitivity, specificity, likelihood ratios, and area under the summary receiver-operating characteristic curve.
PubMed and EMBASE/Excerpta Medica were searched from 1980 to August 2009 for original, peer-reviewed publications; reference lists and investigator files were also searched. 40 studies met the inclusion criteria: 31 studies reported on PSI (n = 81 797), 17 on CURB65 (n = 15 596), and 11 on CRB65 (n = 397 211). 31 studies included hospitalized patients only. 16 studies were judged to have good methodology, with low likelihood of significant bias or confounding.
CURB65, CRB65, and PSI did not differ for overall test performance (area under the summary receiver-operating characteristic curve CURB65 0.80, CRB65 0.79, and PSI 0.81; Table).
CURB65, CRB65, and the Pneumonia Severity Index (PSI) does not differ for overall performance in predicting 30-day mortality in patients with community-acquired pneumonia.
Pooled performance characteristics of 3 severity assessment tools for predicting 30-day mortality in patients with community-acquired pneumonia*
*PSI = Pneumonia Severity Index; diagnostic terms and other abbreviations defined in Glossary.
†CURB65 (new-onset mental confusion, urea > 7 mmol/L, respiratory rate ≥ 30 breaths/min, systolic blood pressure < 90 mm Hg or diastolic blood pressure ≤ 60 mm Hg, and age ≥ 65 y); CRB65 (same as CURB65, excluding urea); PSI (20 variables: demographic , comorbid illness , physical examination findings  laboratory findings , and radiographic findings ).
Morris A. Review: CURB65, CRB65, and Pneumonia Severity Index similarly predict mortality in community-acquired pneumonia. Ann Intern Med. ;154:JC4–13. doi: 10.7326/0003-4819-154-8-201104190-02013
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Published: Ann Intern Med. 2011;154(8):JC4-13.
Infectious Disease, Pneumonia, Pulmonary/Critical Care.
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