Document Detail


Confusion, Urea, Respiratory Rate and Shock Index or Adjusted Shock Index (CURSI or CURASI) criteria predict mortality in community-acquired pneumonia.
MedLine Citation:
PMID:  20816599     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Phyo K Myint; Patrick Musonda; Prasanna Sankaran; Deepak N Subramanian; Hannah Ruffell; Alexandra C Smith; Philippa Prentice; Syed M Tariq; Ajay V Kamath
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Publication Detail:
Type:  Journal Article     Date:  2010-08-01
Journal Detail:
Title:  European journal of internal medicine     Volume:  21     ISSN:  1879-0828     ISO Abbreviation:  Eur. J. Intern. Med.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-06     Completed Date:  2010-12-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9003220     Medline TA:  Eur J Intern Med     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  429-33     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Affiliation:
School of Medicine, Health Policy and Practice, Health and Social Sciences Research Institute, Faculty of Health, University of East Anglia, Norwich, Norfolk, UK.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Blood Pressure
Community-Acquired Infections / mortality*,  physiopathology
Confusion / mortality*,  physiopathology
Female
Heart Rate
Humans
Male
Middle Aged
Pneumonia / mortality*,  physiopathology
Predictive Value of Tests
Prospective Studies
Respiratory Rate*
Sensitivity and Specificity
Severity of Illness Index
Shock, Septic / mortality*,  physiopathology
Urea / blood*
Young Adult
Chemical
Reg. No./Substance:
57-13-6/Urea

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