J Korean Med Sci.  2013 Sep;28(9):1276-1282. 10.3346/jkms.2013.28.9.1276.

Mortality of Community-Acquired Pneumonia in Korea: Assessed with the Pneumonia Severity Index and the CURB-65 Score

• Kim HI
• Kim SW
• Chang HH
• Cha SI
• Lee JH
• Ki HK
• Cheong HS
• Yoo KH
• Ryu SY
• Kwon KT
• Lee BK
• Choo EJ
• Kim DJ
• Kang CI
• Chung DR
• Peck KR
• Song JH
• Suh GY
• Shim TS
• Kim YK
• Kim HY
• Moon CS
• Lee HK
• Park SY
• Oh JY
• Jung SI
• Park KH
• Yun NR
• Yoon SH
• Sohn KM
• Kim YS
• Jung KS

• KMID: 1793040
• DOI: http://doi.org/10.3346/jkms.2013.28.9.1276

Abstract

The pneumonia severity index (PSI) and CURB-65 are widely used tools for the prediction of community-acquired pneumonia (CAP). This study was conducted to evaluate validation of severity scoring system including the PSI and CURB-65 scores of Korean CAP patients. In the prospective CAP cohort (participated in by 14 hospitals in Korea from January 2009 to September 2011), 883 patients aged over 18 yr were studied. The 30-day mortalities of all patients were calculated with their PSI index classes and CURB scores. The overall mortality rate was 4.5% (40/883). The mortality rates per CURB-65 score were as follows: score 0, 2.3% (6/260); score 1, 4.0% (12/300); score 2, 6.0% (13/216); score 3, 5.7% (5/88); score 4, 23.5% (4/17); and score 5, 0% (0/2). Mortality rate with PSI risk class were as follows: I, 2.3% (4/174); II, 2.7% (5/182); III, 2.3% (5/213); IV, 4.5% (11/245); and V, 21.7% (15/69). The subgroup mortality rate of Korean CAP patients varies based on the severity scores and CURB-65 is more valid for the lower scores, and PSI, for the higher scores. Thus, these variations must be considered when using PSI and CURB-65 for CAP in Korean patients.

Keyword

Pneumonia; Prognosis; Severity Index

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Asian Continental Ancestry Group
Cohort Studies
Community-Acquired Infections/*mortality
Female
Humans
Intensive Care Units
Male
Middle Aged
Pneumonia/*mortality
Prospective Studies
Republic of Korea
*Severity of Illness Index
Young Adult

Reference

1. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44:S27–S72.

2. Song JH, Jung KS, Kang MW, Kim DJ, Pai H, Suh GY, Shim TS, Ahn JH, Ahn CM, Woo JH, et al. Treatment guidelines for community-acquired pneumonia in Korea: an evidence-based approach to appropriate antimicrobial therapy. Infect Chemother. 2009; 41:133–153.

3. Bartlett JG, Dowell SF, Mandell LA, File TM Jr, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults: Infectious Diseases Society of America. Clin Infect Dis. 2000; 31:347–382.

4. Mandell LA, Marrie TJ, Grossman RF, Chow AW, Hyland RH. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society: the Canadian Community-Acquired Pneumonia Working Group. Clin Infect Dis. 2000; 31:383–421.

5. Neill AM, Martin IR, Weir R, Anderson R, Chereshsky A, Epton MJ, Jackson R, Schousboe M, Frampton C, Hutton S, et al. Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. Thorax. 1996; 51:1010–1016.

6. Woodhead MA, Macfarlane JT, McCracken JS, Rose DH, Finch RG. Prospective study of the aetiology and outcome of pneumonia in the community. Lancet. 1987; 1:671–674.

7. Almirall J, Bolíbar I, Vidal J, Sauca G, Coll P, Niklasson B, Bartolomé M, Balanzó X. Epidemiology of community-acquired pneumonia in adults: a population-based study. Eur Respir J. 2000; 15:757–763.

8. Angus DC, Marrie TJ, Obrosky DS, Clermont G, Dremsizov TT, Coley C, Fine MJ, Singer DE, Kapoor WN. Severe community-acquired pneumonia: use of intensive care services and evaluation of American and British Thoracic Society Diagnostic criteria. Am J Respir Crit Care Med. 2002; 166:717–723.

9. McQuillan P, Pilkington S, Allan A, Taylor B, Short A, Morgan G, Nielsen M, Barrett D, Smith G, Collins CH. Confidential inquiry into quality of care before admission to intensive care. BMJ. 1998; 316:1853–1858.

10. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997; 336:243–250.

11. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003; 58:377–382.

12. Capelastegui A, España PP, Quintana JM, Areitio I, Gorordo I, Egurrola M, Bilbao A. Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J. 2006; 27:151–157.

13. Fine MJ, Singer DE, Hanusa BH, Lave JR, Kapoor WN. Validation of a pneumonia prognostic index using the MedisGroups Comparative Hospital Database. Am J Med. 1993; 94:153–159.

14. Fine MJ, Stone RA, Singer DE, Coley CM, Marrie TJ, Lave JR, Hough LJ, Obrosky DS, Schulz R, Ricci EM, et al. Processes and outcomes of care for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team (PORT) Cohort Study. Arch Intern Med. 1999; 159:970–980.

15. Chalmers JD, Rutherford J. Can we use severity assessment tools to increase outpatient management of community-acquired pneumonia? Eur J Intern Med. 2012; 23:398–406.

16. Park SY, Park S, Lee MG, Kim DG, Suh GY, Kim C, Lee CY, Park YB, Jung KS. Minor criteria of Infectious Disease Society of America/American Thoracic Society for severe community-acquired pneumonia can predict delayed treatment response. J Korean Med Sci. 2012; 27:907–913.

17. Delgado M, Alvarez MM, Carrascosa I, Rodríguez-Velasco M, Barrios JL, Canut A. The routine use of the Pneumonia Severity Index in the emergency department: effect on process-of-care indicators and results in community acquired pneumonia. Enferm Infecc Microbiol Clin. 2013; 31:289–297.

18. Naughton BJ, Mylotte JM. Treatment guideline for nursing home-acquired pneumonia based on community practice. J Am Geriatr Soc. 2000; 48:82–88.

19. Chong YP, Jung KS, Lee KH, Kim MN, Moon SM, Park S, Hur J, Kim DM, Jeon MH, Woo JH. The bacterial etiology of community-acquired pneumonia in Korea: a nationwide prospective multicenter study. Infect Chemother. 2010; 42:397–403.