PURPOSE: Patients with community-acquired pneumonia (CAP) comprised 35.6% of the PROWESS study and 33.1% of the placebo arm. We investigated the use of CURB-65, the Pneumonia Severity Index (PSI) and APACHE II prediction scores to identify the CAP population from the PROWESS placebo arm at the greatest mortality risk.
METHODS: Patients were classified as having CAP if the lung was the primary infection site and the patient originated from home. The abilities of CURB-65, PSI and APACHE II scores to determine 28-day and in-hospital mortality were compared using receiver operator characteristic (ROC) curves and the associated areas under the curve.
RESULTS: PROWESS enrolled 278 CAP patients in the placebo arm. The areas under the ROC curves for PSI =5, CURB-65 ≥3, and APACHE II ≥25 for predicting 28-day (c =0.65, 0.66, 0.64, respectively) and in-hospital mortality (c =0.65, 0.65, 0.64, respectively) were not statistically different from each other. The 28-day mortality of patients with a PSI score =5, CURB-65 ≥3 and APACHE II ≥25 was 41.6%, 37.9%, and 43.5% respectively.
CONCLUSION: Despite early diagnosis and appropriate antibiotic therapy, conventionally treated CAP with PSI scores =5, CURB-65 scores ≥3, or APACHE II ≥25 has an unacceptably high mortality. In this study, PSI, CURB-65 and APACHE II scoring systems perform similarly in predicting 28-day and in-hospital mortality.
CLINICAL IMPLICATIONS: The PSI and APACHE II are cumbersome and time-consuming to perform while CURB-65 is simple and rapid and may provide more efficient risk stratification in patients with severe CAP. CTR#1678.
DISCLOSURE: Guy Richards, No Product/Research Disclosure Information; Shareholder I hold shares of stock in Eli Lilly and Company; Employee I am a full-time employee of Eli Lilly and Company