• Hai-yan Li, Qi Guo, Wei-dong Song, Yi-ping Zhou, Ming Li, Xiao-ke Chen, Hui Liu, Hong-lin Peng, Hai-qiong Yu, Xia Chen, Nian Liu, Zhong-dong Lü, Li-hua Liang, Qing-zhou Zhao, and Mei Jiang.
• Department of Primary Care (H-YL), Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China; Department of Respiratory Medicine (QG, Y-PZ, ML, X-KC, HL, H-LP, H-QY, XC, NL), Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China; Department of Respiratory Medicine (W-DS, Z-DL), Affiliated Shenzhen Hospital, Peking University, Shenzhen, Guangdong, China; Department of Radiology (L-HL, Q-ZZ), Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China; and Guangzhou Institute of Respiratory Diseases (State Key Laboratory of Respiratory Diseases) (MJ), First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
• Am. J. Med. Sci. 2015 Sep 1; 350 (3): 186-90.

BackgroundIt is not clear whether low-blood pressure criterion could be removed from CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30/min, low blood pressure and age ≥65 years) score to orchestrate an improvement in identifying patients with community-acquired pneumonia (CAP) in low-mortality rate settings.MethodsA retrospective cohort study of 1,230 CAP patients was performed to simplify the CURB-65 scoring system by excluding low-blood pressure variable. The simplification was validated in a prospective 2-center cohort of 1,409 adults with CAP.ResultsThe hospital mortalities were 1.3% and 3.8% in the retrospective and prospective cohorts, respectively. The mortality rates in the 2 cohorts increased directly with the increasing scores, showing significant increased odds ratios for mortality. The pattern of sensitivity, specificity, positive predictive value and Youden's index of a CUR-65 (Confusion, Urea >7 mmol/L, Respiratory rate ≥30/min and age ≥65 years) score of ≥2 for prediction of mortality was better than that of a CURB-65 score of ≥3 in the retrospective cohort. Higher values of corresponding indices were confirmed in the validation cohort. The higher accuracy of CUR-65 score for predicting mortality was illustrated by the area under the receiver operating characteristic curve of 0.937, compared with 0.915 for CURB-65 score in the retrospective cohort (P = 0.0073). The validation cohort confirmed a similar paradigm (0.953 versus 0.907, P = 0.0002).ConclusionsCURB-65 score could be simplified by removing low blood pressure to orchestrate an improvement in predicting mortality in CAP patients who have a low risk of death. A CUR-65 score of ≥2 might be a more valuable cutoff value for severe CAP.

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