387. The Clinical Value of Pneumonia Severity Index and CURB-65 Measurement in Community Acquired pneumonia and Health-Care Associated Pneumonia
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Health-care associated pneumonia (HCAP) has been reviewed as another type of community acquired pneumonia. Although Pneumonia Severity Index (PSI) and CURB-65 has been well evaluated for mortality prediction in patients with community acquired pneumonia (CAP), its value in HCAP has never been explored.
Methods: This prospective observational study enrolled patients with radiographically-confirmed CAP or HCAP hospitalized to a local hospital at south Taiwan from January 1, 2007 to December 31, 2007. Patients were stratified into 5 risk classes according to PSI score or CURB-65.
Results: 178 patients classified as CAP and 172 patients classified as HCAP were enrolled in this study. The overall 30-day mortality of both CAP and HCAP patients was 10.3%. According to PSI grading system, the 30-day mortality was 0%, 0%, 0%, 6.7%, 14% for CAP patients and 0%, 0%, 0%, 10.8%, 15.3% for HCAP patients in each class. Using CURB-65, the 30-day mortality rate was 0%, 1.7%, 8.2%, 36.8%, 12.5% for CAP patients and 0%, 5.3%, 13.3%, 17.2%, 33.3%, 33.3% for HCAP patients in each class. In CAP patients, CURB score had a better area-under-curve value compared with PSI or CURB-65 scores (0.86, 0.677 and 0.805, respectively). In patients with HCAP, the area-under-curve value of each scoring system was not as predictive as that in CAP patients. CURB and CURB-65 scores had similar area-under-curve values (0.695 and 0.698) and these two scores were more predictive than PSI score (0.574).
Conclusion: CURB-65 and CURB scores were more predictive scores for 30-day mortality in patients with HCAP than the PSI score.
Jung-Yien Chien, MD, MS1, Yu-Min Chuang, MD1, Ya-Chi Ho, MD, MS2 and  Y. Chuang, None..
Y. Ho, None..
J. Chien, None., (1)National Taiwan University Hospital, Taipei, Taiwan, (2)National Taiwan University Hospital, Baltimore, MD