Abdul Razak, Nurul Majidah
(2015)
The prognostic ability of curb-65 in predicting outcomes of hospitalised patients with community acquired pneumonia in Hospital Universiti Sains Malaysia.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background
Community Acquired pneumonia (CAP) is a common disease and many patients
require admission, which is about 20-40% of patients. It also has high morbidity and
mortality. CAP still remains one of the leading causes of death from infectious
diseases. There are several validated tools to assess severity, predict mortality in
patients admitted with CAP and guide clinical decision about the level of intervention
required for better monitoring and treatment.
The purpose of this study is to determine the prognostic ability of CURB-65 as a
pneumonia severity score in predicting outcomes in hospitalized patients with CAP.
Methodology
The study was an observational retrospective cohort study performed for patients
admitted to medical ward and intensive care unit (ICU) HUSM that fulfilled
diagnosis for CAP, from June 2012 till May 2014. The clinical profiles for CAP in
HUSM were elaborated in a descriptive study. The adverse outcomes that were
investigated in this study were use of inotropic support, need of ventilation support,
ICU admission and in hospital mortality. The prognostic ability of CURB-65 in
predicting outcomes were analysed using 4 tests, i.e: Chi square test, SLR, ROC
curve analysis and sensitivity, specificity and predictive values. The recommended
cut off points to indicate higher CURB-65 score was 3 to 5.
Results
The majority of patients were Malay (95.4%) with almost equal male to female
distribution and mean age of 63.29 (SD+16.55) years. The proportion of in hospital
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mortality was 8.8%, use of inotropic support was 11.1% , need of ventilation support
was 12.6% and need of ICU admission was 6.9%. CURB-65 score severity category
demonstrated high sensitivity (89-100%), specificity (84-88%), negative predictive
value (99-100%) and area under ROC curve; and significant association with all the
adverse outcomes. It also had good to excellent discriminative values (0.853-0.938).
Conclusion
Our study showed CURB-65 had a prognostic ability in predicting outcomes i.e: used
of inotropic support, need of ventilation support, need of ICU admission and
inhospital mortality for hospitalised patients with community acquired pneumonia
with high sensitivity and specificity.
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