Integration of CURB-65 and CT Severity Score for Prognostic Prediction in Community-acquired Pneumonia.

Abstract

Objective: This study compared confusion, urea, respiratory rate, blood pressure, age ≥65 years (CURB-65) and computed tomography severity score (CTSS) for predicting 30-day mortality, intensive care unit (ICU) admission, and length of hospital stay in patients with community-acquired pneumonia (CAP) and assessed whether CTSS added prognostic value to CURB-65.

Material and methods: This retrospective study included 456 adults with CT-confirmed CAP. CURB-65 and CTSS were calculated. Multivariable logistic regression and receiver operating characteristic analyses were performed for 30-day mortality and ICU admission, and area under the curve (AUC) values were compared using the DeLong test.

Results: For mortality prediction, the AUC values were 0.894 for CURB-65, 0.762 for mean CTSS, and 0.909 for the combined mortality model. The combined model did not significantly outperform CURB-65 (P = 0.081). For ICU admission, the AUC values were 0.851, 0.716, and 0.881, respectively; the combined ICU model significantly outperformed CURB-65 (P = 0.003). The mean CTSS was independently associated with mortality and ICU admission, but was not associated with length of hospital stay.

Conclusion: CURB-65 remained a strong and practical predictor of mortality and ICU admission in CAP. Mean CTSS provided additional prognostic information for mortality and ICU admission, but not for length of hospital stay. The combined mortality model did not significantly improve discrimination compared with CURB-65 alone, whereas the combined ICU model did significantly improve discrimination in predicting ICU admission.