Table 38-2.
Comparison of Studies for Prognostic Scores on Pneumonia Severity
| Study | No. of Patients | Outcome Predictor | Prediction Rule | Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) |
|---|---|---|---|---|---|---|---|
| Farr B, 199124 | 245 | Mortality | Original BTS rule 1 | 70 | 84 | 29 | 97 |
| Karalus N, 199125 | 92 | Mortality | Original BTS rule 1 | 83 | 80 | 23 | 99 |
| Ewig, 199526 | 92 | Mortality | Original BTS rule 1 | 65 | 73 | 21 | 95 |
| Original BTS rule 2 | 47 | 88 | 31 | 94 | |||
| Neill A, 199627 | 122 deceased* | Mortality | Modified BTS (CURB ≥ 2)† | 95 | 71 | 22 | 99 |
| Original BTS rule 1 | 90 | 76 | 25 | 99 | |||
| Original BTS rule 2 | 90 | 88 | 33 | 97 | |||
| Ewig S, 199828 | 395 | Need for ICU admission | Modified ATS | 78 | 94 | 75 | 95 |
| Conte H, 199929 | 2356 | Mortality | Original BTS rule 1‡ | 50 | 70 | NR | NR |
| Lim W, 200018 | 181 deceased* | Mortality | Modified BTS (CURB ≥ 2) | 66 | 73 | NR | NR |
| Lim W, 200316 | 1068 | 30-day mortality | Modified BTS (CURB-65 ≥ 3) | 68.1 | 74.9 | 22.4 | 95.7 |
| Derivation cohort (718 pts)† | 75 | 74.7 | 23.4 | 96.7 | |||
| Validation cohort (214 pts) | |||||||
| Ewig, 200419 | 696 | 30-day mortality | Modified ATS | 94 (95% CI, 82.5-98.7) | 93 (95% CI, 90.6-94.7) | 49 (95% CI, 38.2-59.7) | 99.5 (95% CI, 98.5-99.9) |
| Modified BTS (CURB ≥ 2) | 51 (95% CI, 35.5-67.1) | 80 (95% CI, 76.3-83.1) | 16 (95% CI, 10.1-23.3) | 96 (95% CI, 93.4-97.3) | |||
| Aujesky D, 200520 | 3181 | Mortality | PSI ≥ 4 | 79 (95% CI, 71-85) | 70 (95% CI, 68-72) | 13 (95% CI, 11-17) | 99 (95% CI, 98-99) |
| CURB ≥ 2 | 47 (95% CI, 39-55) | 85 (95% CI, 84-87) | 13 (95% CI, 11-17) | 97 (95% CI, 96-98) | |||
| CURB-65 ≥ 3 | 45 (95% CI, 37-53) | 87 (95% CI, 86-88) | 14 (95% CI, 11-18) | 97 (95% CI, 96-98) | |||
| España, 2006 | 1057 | Mortality, need for mechanical ventilation and/or septic shock | SCAP prediction rule†§ | 92.1 | 95.97 | 21.4 | 99.2 |
| Modified ATS | 51.3 | 95.9 | 49.4 | 96.2 | |||
| CURB-65 ≥ 3 | 68.4 | 86.8 | 28.6 | 97.3 | |||
| PSI ≥ 4 | 94.7 | 68.1 | 18.7 | 99.4 | |||
| Adjusted PSI (classes I-III with oxygen desaturation and PSI ≥ IV) | 97.4 | 57.5 | 15.1 | 99.7 |
ATS, American Thoracic Society; BTS, British Thoracic Society; CI, confidence interval; CURB, confusion, serum urea, respiratory rate, blood pressure; ICU, intensive care unit; NPV, negative predictive value; NR, not reported; PPV, positive predictive value; PSI, Pneumonia Severity Index; SCAP, severe community-acquired pneumonia.
*
Indicates derivation studies.
†
Case-control studies.
‡
All patients ≥ 65 yr or older.
§
9/20 Variables also present in PSI + multi-lobar chest radiograph.