• T T Bauer, S Ewig, R Marre, N Suttorp, T Welte, and CAPNETZ Study Group.
• HELIOS Clinic Emil v. Behring, Respiratory Diseases Clinic Heckeshorn, Berlin, Germany.
• J. Intern. Med. 2006 Jul 1; 260 (1): 93-101.

ObjectiveThe study was performed to validate the CURB, CRB and CRB-65 scores for the prediction of death from community-acquired pneumonia (CAP) in both the hospital and out-patient setting.DesignData were derived from a large multi-centre prospective study initiated by the German competence network for community-acquired pneumonia (CAPNETZ) which started in March 2003 and were censored for this analysis in October 2004.SettingOut- and in-hospital patients in 670 private practices and 10 clinical centres.SubjectsAnalysis was done for n = 1343 patients (n = 208 out-patients and n = 1135 hospitalized) with all data sets completed for the calculation of CURB and repeated for n = 1967 patients (n = 482 out-patients and n = 1485 hospitalized) with complete data sets for CRB and CRB-65.InterventionNone. 30-day mortality from CAP was determined by personal contacts or a structured interview.ResultsOverall 30-day mortality was 4.3% (0.6% in out-patients and 5.5% in hospitalized patients, P < 0.0001). Overall, the CURB, CRB and CRB-65 scores provided comparable predictions for death from CAP as determined by receiver-operator-characteristics (ROC) curves. However, in hospitalized patients, CRB misclassified 26% of deaths as low risk patients. Availability of the CRB-65 score (90%) was far superior to that of CURB (65%), due to missing blood urea nitrogen values (P < 0.001).ConclusionsBoth the CURB and CRB-65 scores can be used in the hospital and out-patients setting to assess pneumonia severity and the risk of death. Given that the CRB-65 is easier to handle, we favour the use of CRB-65 where blood urea nitrogen is unavailable.

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