Comparison of the Prognostic Performance of the CURB-65 and a Modified Version of the Pneumonia Severity Index Designed to Identify High-Risk Patients Using the International Community-Acquired Pneumonia Collaboration Cohort

Raphae Barlas; Allan B Clark; Yoon Kong Loke; Chun Shing Kwok; Derek C Angus; Ane  Uranga; Pedro P España; Dean T Eurich; David T Huang; Shin Yan Man; Timothy H Rainer; Donald M Yealy; Phyo K Myint; Maria K  Mor; Michael J Fine

doi:10.1016/j.rmed.2022.106884

Comparison of the Prognostic Performance of the CURB-65 and a Modified Version of the Pneumonia Severity Index Designed to Identify High-Risk Patients Using the International Community-Acquired Pneumonia Collaboration Cohort

Raphae Barlas, Allan B Clark, Yoon Kong Loke, Chun Shing Kwok, Derek C Angus, Ane Uranga, Pedro P España, Dean T Eurich, David T Huang, Shin Yan Man, Timothy H Rainer, Donald M Yealy, Phyo K Myint, Maria K Mor, Michael J Fine^* (Corresponding Author)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

1 Downloads (Pure)

Abstract

Background: Although the PSI and CURB-65 represent well-validated prediction rules for pneumonia prognosis, PSI was designed to identify patients at low risk and CURB- 65 patients at high risk of mortality. We compared the prognostic performance of a modified version of the PSI designed to identify high-risk patients (i.e., PSI-HR) to CURB-65 in predicting short-term mortality.
Methods: Using data from 6 pneumonia cohorts, we designed PSI-HRs a 6-class prediction rule using the original prognostic weights of all PSI variables and modifying the risk score thresholds to define risk classes. We calculated the proportion of low-risk and high-risk patients using CURB-65 and PSI-HR and 30-day mortality in these subgroups. We compared the rules’ sensitivity, specificity, positive and negative predictive values for mortality all risk class thresholds and assessed discriminatory power using areas under their receiver operating characteristic curves (AUROCs).
Results: Among 13,874 patients with pneumonia, 1036 (7.5%) died. For PSI-HR versus CURB-65, aggregate mortality was lower in low-risk patients (1.6% vs. 2.2 %, p=0.005) and higher in high-risk patients (36.5% vs. 32.2%, p=0.27). PSI-HR had higher sensitivities than CURB-65 at all thresholds; PSI-HR also had higher specificities at the 3 lowest thresholds and specificities within 0.5 percentage points of CURB-65 at the 2 highest thresholds. The AUROC was larger for PSI-HR than CURB- 65 (0.82 vs. 0.77, p<0.0001).
Conclusions: PSI-HR demonstrated superior prognostic accuracy to CURB-65 at the lower end of the severity spectrum and identified high-risk patients with nonsignificant higher short-term mortality at the higher end.

Original language	English
Article number	106884
Number of pages	6
Journal	Respiratory Medicine
Volume	200
Early online date	26 Jun 2022
DOIs	https://doi.org/10.1016/j.rmed.2022.106884
Publication status	Published - 1 Sept 2022

Bibliographical note

Acknowledgments Author contributions: MJF and RSB are the guarantors of the content of the manuscript, including the data and analysis. RSB and MJF were responsible for writing and revision of the manuscript. All authors contributed to the conceptualization of the study design, had access to the study data and review and synthesis of the final version of this manuscript. The authors wish to especially thank Dr. Thomas J. Marrie (Dalhousie University) for his expertise and critical review of the manuscript.
Funding information: The authors received no financial support for the research, authorship, and/or publication of this article.

Data Availability Statement

Supplementary data to this article can be found online at https://doi.org/10.1016/j.rmed.2022.106884.

Keywords

prognosis
severity of illness
pneumonia
prediction rules

Access to Document

10.1016/j.rmed.2022.106884Licence: Unspecified

Barlas_etal_comparison_of_the_AAM
this manuscript is available under CC BY NC ND licence. https://creativecommons.org/licenses/by-nc-nd/4.0/
Accepted author manuscript, 1.42 MBLicence: CC BY-NC-ND

Fingerprint

Dive into the research topics of 'Comparison of the Prognostic Performance of the CURB-65 and a Modified Version of the Pneumonia Severity Index Designed to Identify High-Risk Patients Using the International Community-Acquired Pneumonia Collaboration Cohort'. Together they form a unique fingerprint.

Cite this

Barlas, R., Clark, A. B., Loke, Y. K., Kwok, C. S., Angus, D. C., Uranga, A., España, P. P., Eurich, D. T., Huang, D. T., Man, S. Y., Rainer, T. H., Yealy, D. M., Myint, P. K., Mor, M. K., & Fine, M. J. (2022). Comparison of the Prognostic Performance of the CURB-65 and a Modified Version of the Pneumonia Severity Index Designed to Identify High-Risk Patients Using the International Community-Acquired Pneumonia Collaboration Cohort. Respiratory Medicine, 200, Article 106884. https://doi.org/10.1016/j.rmed.2022.106884

Comparison of the Prognostic Performance of the CURB-65 and a Modified Version of the Pneumonia Severity Index Designed to Identify High-Risk Patients Using the International Community-Acquired Pneumonia Collaboration Cohort. / Barlas, Raphae; Clark, Allan B; Loke, Yoon Kong et al.
In: Respiratory Medicine, Vol. 200, 106884, 01.09.2022.

Research output: Contribution to journal › Article › peer-review

Barlas, R, Clark, AB, Loke, YK, Kwok, CS, Angus, DC, Uranga, A, España, PP, Eurich, DT, Huang, DT, Man, SY, Rainer, TH, Yealy, DM, Myint, PK, Mor, MK & Fine, MJ 2022, 'Comparison of the Prognostic Performance of the CURB-65 and a Modified Version of the Pneumonia Severity Index Designed to Identify High-Risk Patients Using the International Community-Acquired Pneumonia Collaboration Cohort', Respiratory Medicine, vol. 200, 106884. https://doi.org/10.1016/j.rmed.2022.106884

Barlas R, Clark AB, Loke YK, Kwok CS, Angus DC, Uranga A et al. Comparison of the Prognostic Performance of the CURB-65 and a Modified Version of the Pneumonia Severity Index Designed to Identify High-Risk Patients Using the International Community-Acquired Pneumonia Collaboration Cohort. Respiratory Medicine. 2022 Sept 1;200:106884. Epub 2022 Jun 26. doi: 10.1016/j.rmed.2022.106884

@article{956c57ce53b24e5d9c294f4c236be1aa,

title = "Comparison of the Prognostic Performance of the CURB-65 and a Modified Version of the Pneumonia Severity Index Designed to Identify High-Risk Patients Using the International Community-Acquired Pneumonia Collaboration Cohort",

abstract = "Background: Although the PSI and CURB-65 represent well-validated prediction rules for pneumonia prognosis, PSI was designed to identify patients at low risk and CURB- 65 patients at high risk of mortality. We compared the prognostic performance of a modified version of the PSI designed to identify high-risk patients (i.e., PSI-HR) to CURB-65 in predicting short-term mortality.Methods: Using data from 6 pneumonia cohorts, we designed PSI-HRs a 6-class prediction rule using the original prognostic weights of all PSI variables and modifying the risk score thresholds to define risk classes. We calculated the proportion of low-risk and high-risk patients using CURB-65 and PSI-HR and 30-day mortality in these subgroups. We compared the rules{\textquoteright} sensitivity, specificity, positive and negative predictive values for mortality all risk class thresholds and assessed discriminatory power using areas under their receiver operating characteristic curves (AUROCs).Results: Among 13,874 patients with pneumonia, 1036 (7.5%) died. For PSI-HR versus CURB-65, aggregate mortality was lower in low-risk patients (1.6% vs. 2.2 %, p=0.005) and higher in high-risk patients (36.5% vs. 32.2%, p=0.27). PSI-HR had higher sensitivities than CURB-65 at all thresholds; PSI-HR also had higher specificities at the 3 lowest thresholds and specificities within 0.5 percentage points of CURB-65 at the 2 highest thresholds. The AUROC was larger for PSI-HR than CURB- 65 (0.82 vs. 0.77, p<0.0001).Conclusions: PSI-HR demonstrated superior prognostic accuracy to CURB-65 at the lower end of the severity spectrum and identified high-risk patients with nonsignificant higher short-term mortality at the higher end.",

keywords = "prognosis, severity of illness, pneumonia, prediction rules",

author = "Raphae Barlas and Clark, {Allan B} and Loke, {Yoon Kong} and Kwok, {Chun Shing} and Angus, {Derek C} and Ane Uranga and Espa{\~n}a, {Pedro P} and Eurich, {Dean T} and Huang, {David T} and Man, {Shin Yan} and Rainer, {Timothy H} and Yealy, {Donald M} and Myint, {Phyo K} and Mor, {Maria K} and Fine, {Michael J}",

note = "Acknowledgments Author contributions: MJF and RSB are the guarantors of the content of the manuscript, including the data and analysis. RSB and MJF were responsible for writing and revision of the manuscript. All authors contributed to the conceptualization of the study design, had access to the study data and review and synthesis of the final version of this manuscript. The authors wish to especially thank Dr. Thomas J. Marrie (Dalhousie University) for his expertise and critical review of the manuscript. Funding information: The authors received no financial support for the research, authorship, and/or publication of this article.",

year = "2022",

month = sep,

day = "1",

doi = "10.1016/j.rmed.2022.106884",

language = "English",

volume = "200",

journal = "Respiratory Medicine",

issn = "0954-6111",

publisher = "Elsevier",

}

TY - JOUR

T1 - Comparison of the Prognostic Performance of the CURB-65 and a Modified Version of the Pneumonia Severity Index Designed to Identify High-Risk Patients Using the International Community-Acquired Pneumonia Collaboration Cohort

AU - Barlas, Raphae

AU - Clark, Allan B

AU - Loke, Yoon Kong

AU - Kwok, Chun Shing

AU - Angus, Derek C

AU - Uranga, Ane

AU - España, Pedro P

AU - Eurich, Dean T

AU - Huang, David T

AU - Man, Shin Yan

AU - Rainer, Timothy H

AU - Yealy, Donald M

AU - Myint, Phyo K

AU - Mor, Maria K

AU - Fine, Michael J

N1 - Acknowledgments Author contributions: MJF and RSB are the guarantors of the content of the manuscript, including the data and analysis. RSB and MJF were responsible for writing and revision of the manuscript. All authors contributed to the conceptualization of the study design, had access to the study data and review and synthesis of the final version of this manuscript. The authors wish to especially thank Dr. Thomas J. Marrie (Dalhousie University) for his expertise and critical review of the manuscript. Funding information: The authors received no financial support for the research, authorship, and/or publication of this article.

PY - 2022/9/1

Y1 - 2022/9/1

N2 - Background: Although the PSI and CURB-65 represent well-validated prediction rules for pneumonia prognosis, PSI was designed to identify patients at low risk and CURB- 65 patients at high risk of mortality. We compared the prognostic performance of a modified version of the PSI designed to identify high-risk patients (i.e., PSI-HR) to CURB-65 in predicting short-term mortality.Methods: Using data from 6 pneumonia cohorts, we designed PSI-HRs a 6-class prediction rule using the original prognostic weights of all PSI variables and modifying the risk score thresholds to define risk classes. We calculated the proportion of low-risk and high-risk patients using CURB-65 and PSI-HR and 30-day mortality in these subgroups. We compared the rules’ sensitivity, specificity, positive and negative predictive values for mortality all risk class thresholds and assessed discriminatory power using areas under their receiver operating characteristic curves (AUROCs).Results: Among 13,874 patients with pneumonia, 1036 (7.5%) died. For PSI-HR versus CURB-65, aggregate mortality was lower in low-risk patients (1.6% vs. 2.2 %, p=0.005) and higher in high-risk patients (36.5% vs. 32.2%, p=0.27). PSI-HR had higher sensitivities than CURB-65 at all thresholds; PSI-HR also had higher specificities at the 3 lowest thresholds and specificities within 0.5 percentage points of CURB-65 at the 2 highest thresholds. The AUROC was larger for PSI-HR than CURB- 65 (0.82 vs. 0.77, p<0.0001).Conclusions: PSI-HR demonstrated superior prognostic accuracy to CURB-65 at the lower end of the severity spectrum and identified high-risk patients with nonsignificant higher short-term mortality at the higher end.

AB - Background: Although the PSI and CURB-65 represent well-validated prediction rules for pneumonia prognosis, PSI was designed to identify patients at low risk and CURB- 65 patients at high risk of mortality. We compared the prognostic performance of a modified version of the PSI designed to identify high-risk patients (i.e., PSI-HR) to CURB-65 in predicting short-term mortality.Methods: Using data from 6 pneumonia cohorts, we designed PSI-HRs a 6-class prediction rule using the original prognostic weights of all PSI variables and modifying the risk score thresholds to define risk classes. We calculated the proportion of low-risk and high-risk patients using CURB-65 and PSI-HR and 30-day mortality in these subgroups. We compared the rules’ sensitivity, specificity, positive and negative predictive values for mortality all risk class thresholds and assessed discriminatory power using areas under their receiver operating characteristic curves (AUROCs).Results: Among 13,874 patients with pneumonia, 1036 (7.5%) died. For PSI-HR versus CURB-65, aggregate mortality was lower in low-risk patients (1.6% vs. 2.2 %, p=0.005) and higher in high-risk patients (36.5% vs. 32.2%, p=0.27). PSI-HR had higher sensitivities than CURB-65 at all thresholds; PSI-HR also had higher specificities at the 3 lowest thresholds and specificities within 0.5 percentage points of CURB-65 at the 2 highest thresholds. The AUROC was larger for PSI-HR than CURB- 65 (0.82 vs. 0.77, p<0.0001).Conclusions: PSI-HR demonstrated superior prognostic accuracy to CURB-65 at the lower end of the severity spectrum and identified high-risk patients with nonsignificant higher short-term mortality at the higher end.

KW - prognosis

KW - severity of illness

KW - pneumonia

KW - prediction rules

U2 - 10.1016/j.rmed.2022.106884

DO - 10.1016/j.rmed.2022.106884

M3 - Article

SN - 0954-6111

VL - 200

JO - Respiratory Medicine

JF - Respiratory Medicine

M1 - 106884

ER -