Prospective Comparison of Prediction Rules of Mortality Risk for CAP in a Developing Country

Setting: Aga Khan University Hospital, Karachi, Pakistan.

Objective: To prospectively compare 30-day mortality with CURB65 and CRB65 scores and the three mortality risk groups (low, intermediate and high) based on these scores in hospitalised patients with community-acquired pneumonia (CAP).

Design: Longitudinal observational cohort study of adult in-patients fulfilling the definition of CAP between October 2006 and May 2007.

Results: A total of 137 patients was included. The 30-day mortality was 13.1%. Areas under the receiver operating characteristic curve for CURB65 and CRB65 scores were respectively 0.863 and 0.835. Odds of death among patients in the high mortality risk group of CURB65 score was 15.4 and those of CRB65 was 11.1 compared with the low and intermediate mortality risk groups combined as reference. CURB65 and CRB65 scores classified 46% and 24.8% patients, respectively, into the low mortality risk group. Length of hospital stay increased with the CURB65 score-based mortality risk groups but not with those based on the CRB65 score.

Conclusion: CURB65 and CRB65 scores showed no significant difference in predicting 30-day mortality. Both scores, and the CURB65 score in particular, categorised reasonable proportions of patients into the low mortality risk group who could be discharged from the emergency room and managed as out-patients.