Prognostic value of Pneumonia Severity Index, CURB-65, CRB-65, and procalcitonin in community-acquired pneumonia in Singapore

Objective: The purpose of this study was to evaluate the performance of three severity scoring tools and procalcitonin (PCT) in severity stratification and mortality prediction among patients with community-acquired pneumonia (CAP) in Singapore. Methods: The method used was a retrospective observati...

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Main Authors: Zoe Xiaozhu Zhang, Weidong Zhang, Ping Liu, Yong Yang, Wan Cheng Tan, Han Seong Ng, Kok Yong Fong
Format: Article
Language:English
Published: SAGE Publishing 2016-09-01
Series:Proceedings of Singapore Healthcare
Online Access:https://doi.org/10.1177/2010105815623292
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author Zoe Xiaozhu Zhang
Weidong Zhang
Ping Liu
Yong Yang
Wan Cheng Tan
Han Seong Ng
Kok Yong Fong
author_facet Zoe Xiaozhu Zhang
Weidong Zhang
Ping Liu
Yong Yang
Wan Cheng Tan
Han Seong Ng
Kok Yong Fong
author_sort Zoe Xiaozhu Zhang
collection DOAJ
description Objective: The purpose of this study was to evaluate the performance of three severity scoring tools and procalcitonin (PCT) in severity stratification and mortality prediction among patients with community-acquired pneumonia (CAP) in Singapore. Methods: The method used was a retrospective observational study of all the consecutive patients with CAP admitted through the emergency department of Singapore General Hospital between 2012–2013. Results: Among 1902 study subjects, the overall 30-day mortality was 15.7%. The mortality rates for Pneumonia Severity Index (PSI) class I–III were 0, 0, and 3.7%, which were comparable to the original published data. CURB-65 and CRB-65 had higher mortality rates in all severity levels. In three levels of risk stratification, the low risk group of PSI (class I–III) included 42.6% of the patients with mortality rate of 1.9%, whereas the low risk group defined by CURB-65 (score 0–1) and CRB-65 (score 0) included 52.0% and 24.4% of the patients with higher mortality rates (7.3% and 4.5% respectively). PSI was the most sensitive in mortality prediction with area under receiver operating characteristic (ROC) curve of 0.82, higher than CURB-65 (0.71), CRB-65 (0.67), and PCT (0.63) ( p <0.001). The initial level of PCT was higher in non-survivors and intensive care unit (ICU)-admitted patients compared to survivors (0.91 vs 0.36 ng/ml, p <0.001) and non-ICU patients (3.70 vs 0.38 ng/ml, p <0.001). Incorporating PCT did not improve the discriminatory power of the scoring tools for mortality prediction. Conclusions: PSI was a reliable tool for severity stratification and morality prediction among the patients with CAP in Singapore.
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spelling doaj.art-0f9561bea5d641f08fb9966d52dce50a2022-12-22T00:54:37ZengSAGE PublishingProceedings of Singapore Healthcare2010-10582059-23292016-09-012510.1177/2010105815623292Prognostic value of Pneumonia Severity Index, CURB-65, CRB-65, and procalcitonin in community-acquired pneumonia in SingaporeZoe Xiaozhu Zhang0Weidong Zhang1Ping Liu2Yong Yang3Wan Cheng Tan4Han Seong Ng5Kok Yong Fong6Epidemiology Department, Singapore General Hospital, SingaporeEpidemiology Department, Singapore General Hospital, SingaporeEpidemiology Department, Singapore General Hospital, SingaporeEpidemiology Department, Singapore General Hospital, SingaporeUBC James Hogg Research Centre, St Paul’s Hospital, CanadaCEO’s Office, Singapore General Hospital, SingaporeDepartment of Rheumatology and Immunology, Singapore General Hospital, SingaporeObjective: The purpose of this study was to evaluate the performance of three severity scoring tools and procalcitonin (PCT) in severity stratification and mortality prediction among patients with community-acquired pneumonia (CAP) in Singapore. Methods: The method used was a retrospective observational study of all the consecutive patients with CAP admitted through the emergency department of Singapore General Hospital between 2012–2013. Results: Among 1902 study subjects, the overall 30-day mortality was 15.7%. The mortality rates for Pneumonia Severity Index (PSI) class I–III were 0, 0, and 3.7%, which were comparable to the original published data. CURB-65 and CRB-65 had higher mortality rates in all severity levels. In three levels of risk stratification, the low risk group of PSI (class I–III) included 42.6% of the patients with mortality rate of 1.9%, whereas the low risk group defined by CURB-65 (score 0–1) and CRB-65 (score 0) included 52.0% and 24.4% of the patients with higher mortality rates (7.3% and 4.5% respectively). PSI was the most sensitive in mortality prediction with area under receiver operating characteristic (ROC) curve of 0.82, higher than CURB-65 (0.71), CRB-65 (0.67), and PCT (0.63) ( p <0.001). The initial level of PCT was higher in non-survivors and intensive care unit (ICU)-admitted patients compared to survivors (0.91 vs 0.36 ng/ml, p <0.001) and non-ICU patients (3.70 vs 0.38 ng/ml, p <0.001). Incorporating PCT did not improve the discriminatory power of the scoring tools for mortality prediction. Conclusions: PSI was a reliable tool for severity stratification and morality prediction among the patients with CAP in Singapore.https://doi.org/10.1177/2010105815623292
spellingShingle Zoe Xiaozhu Zhang
Weidong Zhang
Ping Liu
Yong Yang
Wan Cheng Tan
Han Seong Ng
Kok Yong Fong
Prognostic value of Pneumonia Severity Index, CURB-65, CRB-65, and procalcitonin in community-acquired pneumonia in Singapore
Proceedings of Singapore Healthcare
title Prognostic value of Pneumonia Severity Index, CURB-65, CRB-65, and procalcitonin in community-acquired pneumonia in Singapore
title_full Prognostic value of Pneumonia Severity Index, CURB-65, CRB-65, and procalcitonin in community-acquired pneumonia in Singapore
title_fullStr Prognostic value of Pneumonia Severity Index, CURB-65, CRB-65, and procalcitonin in community-acquired pneumonia in Singapore
title_full_unstemmed Prognostic value of Pneumonia Severity Index, CURB-65, CRB-65, and procalcitonin in community-acquired pneumonia in Singapore
title_short Prognostic value of Pneumonia Severity Index, CURB-65, CRB-65, and procalcitonin in community-acquired pneumonia in Singapore
title_sort prognostic value of pneumonia severity index curb 65 crb 65 and procalcitonin in community acquired pneumonia in singapore
url https://doi.org/10.1177/2010105815623292
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