The 52 in 52 Review: CRB-65 predicts death from community-acquired pneumonia


    The 52 in 52 Review: CRB-65 predicts death from community-acquired pneumonia

    “I quit school in the sixth grade because of pneumonia. Not because I had it, but because I couldn’t spell it.”
    – Rocky Graziano


    Article Citation: Bauer TT, Ewig S, Marre R, Suttorp N, Welte T; CAPNETZ Study Group. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006 Jul;260(1):93-101. PMID: 16789984


    What we already know about the topic: The CURB score is a validated tool for predicting severity in community-acquired pneumonia. It incorporates (1) Confusion, (2) blood Urea nitrogen, (3) Respiratory rate, and (4) Blood pressure.


    Why this study is important: This study was done to validate the CURB, CRB, and CRB-65 scores as inpatient and outpatient severity markers for community acquired pneumonia.


    Brief overview of the study: A large multi-center prospective study was done in Germany at 670 private practices and 10 clinical centers. The study involved 1343 patients (208 outpatient and 1135 inpatient) for the CURB score and 1967 patients (482 outpatient and 1485 inpatient) for the CRB and CRB-65 scores. Overall 30-day mortality was 4.3%, with 0.6% of the outpatients and 5.5% of the inpatients. All 3 scores were comparable for predicting mortality. However, CRB misclassified a number of the mortalities as lower risk patients. CRB-65 could be computed in far more cases than CURB due to the availability of blood urea nitrogen in the data sets.


    Limitations: There was a selection bias from physicians (and therefore patients) due to their interest in joining and participating in the study. This study took place in Germany and may not have matched our population in the U.S.


    Take home points: CURB and CRB-65 can both be used for pneumonia severity and mortality assessment. CRB-65 is easier to use, as it does not require a blood urea nitrogen sample.


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