The utility of CURB-65 scoring in the acute management of radiologically proven pneumonia

Introduction: CURB65 (Confusion with abbreviated mental test score U reau003e7mmol/L, R espiratory rateu003e/=30/minute, B lood pressure /= 65 years) is validated in primary care for triaging community-acquired pneumonia to decide on hospital admission. In UK hospitals, C-Reactive Protein (CRP) level is nearly always done in pneumonia patients but its additional value in predicting mortality is poorly understood. We set out to examine the utility of CURB65 scoring at the point of presentation in hospitalised patients with confirmed pneumonia admitted via unselected general medical take in a district general hospital with and without CRP levels factored in. Methods: Prospective audit of all radiologically proven pneumonia between 20 Sep 2017 and 31 Jan 2018. We estimated the odds of mortality against CURB65, CRP and the product of CRP*CURB65 (for all patients with CURB65 of 1 as there were no dealth in patients with CURB65 score of 0). Results: The total number of patients admitted with radiologically confirmed pneumonia was 87; 17 (19.5%) died in hospital; the estimated odds of death increases by 2.271 times for 1 point increase in CURB65; it was the strongest predictor of in hospital mortality with p=0.003 with the probability of death for CURB65 being:[exp⁡(-3.187+0.820×CURB65) / [1+exp⁡(-3.187+0.820×CURB65)]. CRP and the product of CRP*CURB65 were insignificant predictors with p=0.464 for both parameters. Conclusion: CRP maybe a useful tool in determining factors like duration of antibiotics for patients admitted to hospital with radiologically confirmed pneumonia, but it is useful to risk stratify them at the point of presentation with a CURB65 score regardless of CRP levels.