Confusion, Urea, Respiratory Rate and Shock Index or Adjusted Shock Index (CURSI or CURASI) criteria predict mortality in community-acquired pneumonia

Phyo K Myint, Patrick Musonda, Prasanna Sankaran, Deepak N Subramanian, Hannah Ruffell, Alexandra C Smith, Philippa Prentice, Syed M Tariq, Ajay V Kamath

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Community-acquired pneumonia (CAP) is common and associated with a significant mortality. Shock index, heart rate divided by systolic blood pressure, has been shown to be associated with outcome in sepsis.

OBJECTIVE: To examine the usefulness of two new criteria CURSI (confusion, urea, respiratory rate and shock index), and CURASI where shock index is replaced by temperature adjusted shock index in mortality assessment of CAP.

METHODS: A prospective study was conducted in Norfolk and Suffolk, UK. We explored the usefulness of CURSI and CURASI which we derived and performed mapping exercise using a different cohort. In this study we compared these new indices with the CURB-65 criteria in correctly predicting mortality in CAP.

RESULTS: A total of 190 patients were included (males=53%). The age range was 18-101 years (median=76 years). There were a total of 54 deaths during a six-week follow-up. All died within 30-days. Sixty-five (34%) had severe pneumonia by CURB-65. Using CURSI and CURASI, 71(37%) and 69(36%) had severe pneumonia, respectively. The sensitivity, specificity, positive and negative predictive values in predicting death during six-week follow-up were comparable among three indices examined. The Receiver Operating Characteristic curve values (95%CI) for the criteria were 0.67(0.60-0.75) for CURB-65, 0.67(0.59-0.74) for CURSI and 0.66(0.58-0.74) for CURASI (p>0.05). There were strong agreements between these three indices (Kappa values > or =0.75 for all). Repeating analyses in those who were aged 65years and over (n=135) did not alter the results.

CONCLUSIONS: Both CURSI and CURASI are similarly useful to CURB-65 in predicting deaths associated with CAP including older patients.

Original languageEnglish
Pages (from-to)429-433
Number of pages5
JournalEuropean Journal of Internal Medicine
Volume21
Issue number5
DOIs
Publication statusPublished - Oct 2010

Fingerprint

Respiratory Rate
Urea
Shock
Pneumonia
Mortality
Blood Pressure
ROC Curve
Sepsis
Heart Rate
Prospective Studies
Exercise
Sensitivity and Specificity
Temperature

Keywords

  • adolescent
  • adult
  • aged
  • aged, 80 and over
  • blood pressure
  • community-acquired infections
  • confusion
  • female
  • heart rate
  • humans
  • male
  • middle aged
  • pneumonia
  • predictive value of tests
  • prospective studies
  • respiratory rate
  • sensitivity and specificity
  • severity of illness index
  • shock, septic
  • urea
  • young adult

Cite this

Confusion, Urea, Respiratory Rate and Shock Index or Adjusted Shock Index (CURSI or CURASI) criteria predict mortality in community-acquired pneumonia. / Myint, Phyo K; Musonda, Patrick; Sankaran, Prasanna; Subramanian, Deepak N; Ruffell, Hannah; Smith, Alexandra C; Prentice, Philippa; Tariq, Syed M; Kamath, Ajay V.

In: European Journal of Internal Medicine, Vol. 21, No. 5, 10.2010, p. 429-433.

Research output: Contribution to journalArticle

Myint, Phyo K ; Musonda, Patrick ; Sankaran, Prasanna ; Subramanian, Deepak N ; Ruffell, Hannah ; Smith, Alexandra C ; Prentice, Philippa ; Tariq, Syed M ; Kamath, Ajay V. / Confusion, Urea, Respiratory Rate and Shock Index or Adjusted Shock Index (CURSI or CURASI) criteria predict mortality in community-acquired pneumonia. In: European Journal of Internal Medicine. 2010 ; Vol. 21, No. 5. pp. 429-433.
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abstract = "BACKGROUND: Community-acquired pneumonia (CAP) is common and associated with a significant mortality. Shock index, heart rate divided by systolic blood pressure, has been shown to be associated with outcome in sepsis.OBJECTIVE: To examine the usefulness of two new criteria CURSI (confusion, urea, respiratory rate and shock index), and CURASI where shock index is replaced by temperature adjusted shock index in mortality assessment of CAP.METHODS: A prospective study was conducted in Norfolk and Suffolk, UK. We explored the usefulness of CURSI and CURASI which we derived and performed mapping exercise using a different cohort. In this study we compared these new indices with the CURB-65 criteria in correctly predicting mortality in CAP.RESULTS: A total of 190 patients were included (males=53{\%}). The age range was 18-101 years (median=76 years). There were a total of 54 deaths during a six-week follow-up. All died within 30-days. Sixty-five (34{\%}) had severe pneumonia by CURB-65. Using CURSI and CURASI, 71(37{\%}) and 69(36{\%}) had severe pneumonia, respectively. The sensitivity, specificity, positive and negative predictive values in predicting death during six-week follow-up were comparable among three indices examined. The Receiver Operating Characteristic curve values (95{\%}CI) for the criteria were 0.67(0.60-0.75) for CURB-65, 0.67(0.59-0.74) for CURSI and 0.66(0.58-0.74) for CURASI (p>0.05). There were strong agreements between these three indices (Kappa values > or =0.75 for all). Repeating analyses in those who were aged 65years and over (n=135) did not alter the results.CONCLUSIONS: Both CURSI and CURASI are similarly useful to CURB-65 in predicting deaths associated with CAP including older patients.",
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T1 - Confusion, Urea, Respiratory Rate and Shock Index or Adjusted Shock Index (CURSI or CURASI) criteria predict mortality in community-acquired pneumonia

AU - Myint, Phyo K

AU - Musonda, Patrick

AU - Sankaran, Prasanna

AU - Subramanian, Deepak N

AU - Ruffell, Hannah

AU - Smith, Alexandra C

AU - Prentice, Philippa

AU - Tariq, Syed M

AU - Kamath, Ajay V

N1 - Copyright (c) 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

PY - 2010/10

Y1 - 2010/10

N2 - BACKGROUND: Community-acquired pneumonia (CAP) is common and associated with a significant mortality. Shock index, heart rate divided by systolic blood pressure, has been shown to be associated with outcome in sepsis.OBJECTIVE: To examine the usefulness of two new criteria CURSI (confusion, urea, respiratory rate and shock index), and CURASI where shock index is replaced by temperature adjusted shock index in mortality assessment of CAP.METHODS: A prospective study was conducted in Norfolk and Suffolk, UK. We explored the usefulness of CURSI and CURASI which we derived and performed mapping exercise using a different cohort. In this study we compared these new indices with the CURB-65 criteria in correctly predicting mortality in CAP.RESULTS: A total of 190 patients were included (males=53%). The age range was 18-101 years (median=76 years). There were a total of 54 deaths during a six-week follow-up. All died within 30-days. Sixty-five (34%) had severe pneumonia by CURB-65. Using CURSI and CURASI, 71(37%) and 69(36%) had severe pneumonia, respectively. The sensitivity, specificity, positive and negative predictive values in predicting death during six-week follow-up were comparable among three indices examined. The Receiver Operating Characteristic curve values (95%CI) for the criteria were 0.67(0.60-0.75) for CURB-65, 0.67(0.59-0.74) for CURSI and 0.66(0.58-0.74) for CURASI (p>0.05). There were strong agreements between these three indices (Kappa values > or =0.75 for all). Repeating analyses in those who were aged 65years and over (n=135) did not alter the results.CONCLUSIONS: Both CURSI and CURASI are similarly useful to CURB-65 in predicting deaths associated with CAP including older patients.

AB - BACKGROUND: Community-acquired pneumonia (CAP) is common and associated with a significant mortality. Shock index, heart rate divided by systolic blood pressure, has been shown to be associated with outcome in sepsis.OBJECTIVE: To examine the usefulness of two new criteria CURSI (confusion, urea, respiratory rate and shock index), and CURASI where shock index is replaced by temperature adjusted shock index in mortality assessment of CAP.METHODS: A prospective study was conducted in Norfolk and Suffolk, UK. We explored the usefulness of CURSI and CURASI which we derived and performed mapping exercise using a different cohort. In this study we compared these new indices with the CURB-65 criteria in correctly predicting mortality in CAP.RESULTS: A total of 190 patients were included (males=53%). The age range was 18-101 years (median=76 years). There were a total of 54 deaths during a six-week follow-up. All died within 30-days. Sixty-five (34%) had severe pneumonia by CURB-65. Using CURSI and CURASI, 71(37%) and 69(36%) had severe pneumonia, respectively. The sensitivity, specificity, positive and negative predictive values in predicting death during six-week follow-up were comparable among three indices examined. The Receiver Operating Characteristic curve values (95%CI) for the criteria were 0.67(0.60-0.75) for CURB-65, 0.67(0.59-0.74) for CURSI and 0.66(0.58-0.74) for CURASI (p>0.05). There were strong agreements between these three indices (Kappa values > or =0.75 for all). Repeating analyses in those who were aged 65years and over (n=135) did not alter the results.CONCLUSIONS: Both CURSI and CURASI are similarly useful to CURB-65 in predicting deaths associated with CAP including older patients.

KW - adolescent

KW - adult

KW - aged

KW - aged, 80 and over

KW - blood pressure

KW - community-acquired infections

KW - confusion

KW - female

KW - heart rate

KW - humans

KW - male

KW - middle aged

KW - pneumonia

KW - predictive value of tests

KW - prospective studies

KW - respiratory rate

KW - sensitivity and specificity

KW - severity of illness index

KW - shock, septic

KW - urea

KW - young adult

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M3 - Article

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VL - 21

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JO - European Journal of Internal Medicine

JF - European Journal of Internal Medicine

SN - 0953-6205

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