Severe CAP: Can the CURB65 score and PT discriminate between ICU survivors and non-survivors?
Ricardo Jorge Paixão José, Mohammed Omar, James J. P. Goldring, Rachel Clare Chambers, Jeremy Brown, Banwari Agarwal · European Respiratory Journal · 2013
Introduction: Community acquired pneumonia (CAP) is the most common cause of infectious disease related mortality world-wide. Predicting intensive care (ICU) mortality from severe CAP is important. Our aim was to assess the ability of the CURB65 score and prothrombin time (PT) to discriminate between survivors and non-survivors of CAP admitted to the ICU compared to other mortality prediction scores. Methods: Retrospective review of adult patients with CAP admitted to our ICU between January 2006 and October 2011. CAP was defined as an ICU coding diagnosis of pneumonia and evidence of consolidation on a chest x-ray within 48 hours of hospital admission. Demographic, clinical, laboratory, and outcome data were collected from the ICU and pathology databases. Results : 96 patients with CAP were identified. Patients had severe critical illness, and lung injury, with mean (SD) SAPS II score and lowest P/F ratio of 45 (14) and 132 (70) mmHg respectively on the day of ICU admission. ICU and hospital mortality were 38.5% and 42.7%. Receiver operating curve analysis (AUC) for disease severity scoring systems to predict ICU mortality are listed in Table 1. Conclusion: : The CURB65 score at ICU admission has good ability to discriminate between ICU survivors and non-survivors. The sensitivity of this score may be improved by the addition of a point for prothrombin time >17 s. Receiver operating curve analysis (AUC) for severity of disease scoring systems to predict ICU mortality from CAP Score AUC (95% CI) p value CURB65 0.726 (0.625–0.827) 17 s 0.788 (0.696–0.880) <0.0001 SAPS II 0.802 (0.713–0.892) <0.0001