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...
Main Authors: | , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
SAGE Publishing
2016-09-01
|
Series: | Proceedings of Singapore Healthcare |
Online Access: | https://doi.org/10.1177/2010105815623292 |
_version_ | 1818536633193988096 |
---|---|
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. |
first_indexed | 2024-12-11T18:40:28Z |
format | Article |
id | doaj.art-0f9561bea5d641f08fb9966d52dce50a |
institution | Directory Open Access Journal |
issn | 2010-1058 2059-2329 |
language | English |
last_indexed | 2024-12-11T18:40:28Z |
publishDate | 2016-09-01 |
publisher | SAGE Publishing |
record_format | Article |
series | Proceedings of Singapore Healthcare |
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 |
work_keys_str_mv | AT zoexiaozhuzhang prognosticvalueofpneumoniaseverityindexcurb65crb65andprocalcitoninincommunityacquiredpneumoniainsingapore AT weidongzhang prognosticvalueofpneumoniaseverityindexcurb65crb65andprocalcitoninincommunityacquiredpneumoniainsingapore AT pingliu prognosticvalueofpneumoniaseverityindexcurb65crb65andprocalcitoninincommunityacquiredpneumoniainsingapore AT yongyang prognosticvalueofpneumoniaseverityindexcurb65crb65andprocalcitoninincommunityacquiredpneumoniainsingapore AT wanchengtan prognosticvalueofpneumoniaseverityindexcurb65crb65andprocalcitoninincommunityacquiredpneumoniainsingapore AT hanseongng prognosticvalueofpneumoniaseverityindexcurb65crb65andprocalcitoninincommunityacquiredpneumoniainsingapore AT kokyongfong prognosticvalueofpneumoniaseverityindexcurb65crb65andprocalcitoninincommunityacquiredpneumoniainsingapore |