PURPOSE:Optimal management of Community Acquired Pneumonia (CAP) requires prompt recognition of patients for proper disposition to inpatient ward or intensive care unit (ICU). The role of Body Mass Index (BMI) on CAP based on CURB-65 scoring system has not been well studied.
METHODS:We conducted a retrospective study on patients admitted with CAP from 2005–2007. Obese patients with BMI ≥ 30 kg/m2 (Group 1) and non-obese patients with BMI ≤; 29.9 kg/m2 (Group 2) were compared. Inclusion criteria were: new infiltrate on chest X-ray, and two of either: fever >100.4°F, productive cough, or shortness of breath. Immunocompromised and those on mechanical ventilation were excluded. Data was analyzed with SPSS-16.0 software.
RESULTS:Data on 110 patients (42 in group 1 and 68 in group 2) was analyzed. Obese patients with lower CURB-65 scores (0–1) were more likely to be admitted to ICU than non-obese patients with higher scores (3–4). Moreover, obese patients were more likely to have invasive procedures, such as tracheotomy, and placement of central venous catheters (RR 2.59, CI 1.04 –6.46). There was a direct correlation with increasing BMI and lower PaO2/FiO2 ratio (r=0.43, p=0.02). Group 1 also had a greater need for Non-Invasive Positive Pressure Ventilation (NIPPV)/Mechanical Ventilation (MV) 21.4% vs. 8.8% (OR=3.1, CI 1.5–9.17). After controlling for co-morbidities obese individuals had longer ICU length of stay (5.8 ± 7.5 days) and wards length of stay (6.75±6.9 days) as compared to non-obese group (2.5 ± 4 days) and (4.7 ± 4.47 days), respectively. There was, however, no difference in mortality.
CONCLUSION:Obese patients with CAP are more likely to need intensive care despite lower CURB-65 scores. They have prolonged hospital course, increased need for NIPPV/MV, and are subjected to more invasive procedures.
CLINICAL IMPLICATIONS:Obesity should be taken into consideration when evaluating disposition of a patient with CAP using CURB-65. Should CURB-65 be renamed as CURBO-65 (O for Obesity)?.
DISCLOSURE:Sharmili Mathur, None.