Liu et al proposed a modification to the CURB-65 with the addition of 3 more parameters. This can provide an accurate inidication of the severity of community-acquired pneumonia. The authors are from Zhejian University, Chu Kochen Honor College, and Sapienza University in Rome.
Patient selection: community-acquired pneumonia
Outcome: 30-day mortality
Parameters - components of the CURB-65 plus 3 additional:
(1) confusion
(2) urea in mmol/L
(3) respiratory rate in breaths per minute
(4) hypotension (low blood pressure: systolic < 90 mm Hg or diastolic <= 60 mm Hg)
(5) age in years
(6) serum LDH in U/L
(7) serum albumin in g/dL
(8) platelet count in 10^9/L
Parameter
Finding
Points
confusion
absent
0
present
1
urea
<= 7 mmol/L
0
> 7 mmol/L
1
respiratory rate
< 30 breaths per minute
0
>= 30 breaths per minute
1
low blood pressure
absent
0
present
1
age in years
< 65 years
0
>= 65 years
1
serum LDH
<= 230 IU/L
0
> 230 IU/L
1
serum albumin
>= 3.5 g/dL
0
< 3.5 g/dL
1
platelet count
>= 100 * 10^9/L
0
< 100 * 10^9/L
1
where:
• A pulse >= 125 beats per minute and serum C-reactive protein > 150 mg/L both had a p value of 0.6.
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• minimum score: 8
• The higher the score the greater the mortality.
Score
30-day Mortality
0 to 2
2.6%
3 or 4
15%
5 to 8
42%
Performance:
• The area under the ROC curve is 0.83.
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