Review Article

Risk Prediction Models for Mortality in Community-Acquired Pneumonia: A Systematic Review

Table 3

Results of derivation and validation studies for pneumonia severity scores.

PaperScore PatientsAge%  maleLost to followup Results

BTS 1987 [22] (derivation)British Thoracic Society Score 1, 2, 3511 patients48.460.528 lost to followupDerivation:
Score 1 (URB): 87.5% sensitivity, 78.7% specificity
Score 2 (CRB): 39.1% sensitivity, 93.9% specificity
Score 3 (COUW): 50% sensitivity, 89% specificity

Farr et al. 1991 [23] (validation)British Thoracic Society Score 1, 2, 3245 patients58.955NoneValidation:
Score 1 (URB): 70% sensitivity, 84.2% specificity, 28.6% PPV, 96.9% NPV, 82.3% overall accuracy
Score 2 (CRB): 35% sensitivity, 88.5% specificity, 21.9% PPV, 93.7% NPV, 84% overall accuracy
Score 3 (COUW): 42.1% sensitivity, 86.6% specificity, 24.2% PPV, 93.6% NPV, 82.4% overall accuracy

Leroy et al. 1996 [14]Mortality risk index460 patients, 335 derivation, 125 validation62.564.3NoneDerivation: 62% sensitivity, 92% specificity, 74% PPV
Validation: 61% sensitivity, 98% specificity, 92% PPV

Neill et al. 1996 [8]CURB255 patients58556 patients, no consent was obtainedDerivation:
CURB: 95% sensitivity, 91% specificity, 22% PPV, 99% NPV
BTS 1: 90% sensitivity, 76% specificity, 25% PPV, 99% NPV
BTS 2: 65% sensitivity, 88% specificity, 33% PPV, 97% NPV
BTS 3: 63% sensitivity, 88% specificity, 32% PPV, 97% NPV

Fine et al. 1997 [11]Pneumonia severity index14199 derivation, 38039 validationNA51NoneDerivation: PSI area ROC 0.84
Validation: PSI area ROC: MedisGroup cohort 0.83, PORT cohort 0.89

Lim et al. 2003 [21]CURB-65, CRB-651068 patients6451.5NoneDerivation:
CURB (>2): 75.4% sensitivity, 68.9% specificity, 20.5% PPV, 96.3% NPV
CURB-65 (>3): 68.1% sensitivity, 74.9% specificity, 22.4% PPV, 95.7% NPV
CRB-65 (>2): 76.8% sensitivity, 64.3% specificity, 18.6% PPV, 96.3% NPV
Validation:
CURB (>2): 75% sensitivity, 70.1% specificity, 20.5% PPV, 96.5% NPV
CURB-65 (>3): 75% sensitivity, 74.7% specificity, 23.4% PPV, 96.7% NPV
CRB-65 (>2): 80% sensitivity, 61.3% specificity, 17.6% PPV, 96.7% NPV

Ewig et al. 2004 [15]Modified American Thoracic Society Rule696 patients67.86621 patients had treatment setting not documented and were excludedValidation
mATS 94% sensitivity, 93% specificity, 49% PPV, 99.5% NPV, 93% overall accuracy
BTS I 46% sensitivity, 87% specificity, 20% PPV, 96% NPV, 85% overall accuracy
BTS II 53% sensitivity, 83% specificity, 19% PPV, 96% NPV, 81% overall accuracy
mBTS 51% sensitivity, 80% specificity, 16% PPV, 96% NPV, 78% overall accuracy

Myint et al. 2006 [24]SOAR195 patients77 (median)57NoneDerivation:
SOAR (≥2): 81.0% sensitivity, 59.3% specificity, 27.0% PPV, 94.4% NPV
CURB (≥2): 81.5% sensitivity, 61.1% specificity, 25.9% PPV, 95.2% NPV
CURB-65 (≥3): 81.5% sensitivity, 64.2% specificity, 27.5% PPV, 95.4% NPV
CRB-65 (≥2): 85.2% sensitivity, 57.0% specificity, 24.5% PPV, 95.9% NPV

Myint et al. 2007 [27] (derivation)CURB age 189 patients75 (median)56.1NoneDerivation:
CURB age: 81.5% sensitivity, 74.1% specificity, 34.4% PPV, 96% NPV
CURB-65: 81.5% sensitivity, 64.2% specificity, 27.5% PPV, 95.4% NPV

Escobar et al. 2008 [25]Abbreviated Fine Score11030 and 6147 patients71.351.2NoneDerivation:
AFFS: area ROC: inhospital mortality: 0.74 and 30-day mortality: 0.75

Shindo et al. 2008 [26]A-DROP371 patients7559.942 (lack data)Validation:
A-DROP: Area ROC 0.846 (0.790–0.903)
CURB-65: Area ROC 0.835 (0.763–0.908)

Myint et al.
2009 [7, 31] (validation)
CURB-age190 patients76 (median)53NoneValidation full cohort:
CURB age: 50.0% sensitivity, 80.1% specificity, 50.0% PPV, 80.1% NPV
CURB-65: 59.3% sensitivity, 75.7% specificity, 49.2% PPV, 82.4% NPV
Validation for the elderly (>65 years):
CURB age: 54.0% sensitivity, 70.6% specificity, 51.9% PPV, 72.3% NPV
CURB-65: 64.0% sensitivity, 65.9% specificity, 52.5% PPV, 75.7% NPV

Myint et al.
2009 [7, 31] (derivation)
CURSI, CURASI118 75 (median)51.7NoneOnly 1 patient died during hospital stay and the patient was scored severe by CURSI, CURASI, and CURB-65

Rello et al. 2009 [28]PIRO score529 patientsNANANoneDerivation:
PIRO: 86% sensitivity, 79% specificity, 61% PPV, 93% NPV, area ROC 0.88

Liapikou et al. 2009 [6]IDSA/ATS 20072391 patients66.761.4289 missing dataValidation:
ATS 2001: 58% sensitivity, 88% specificity

Uchiyama et al. 2010 [29]PARB243 patientsNANANoneDerivation:
PARB: 36% sensitivity, 99% specificity, area ROC 0.8705, accuracy 91.9%

Myint et al. 2010 [30]
(validation)
CURSI, CURASI190 patients76 (median)53NoneValidation full cohort:
CURSI: 61.1% sensitivity, 72.1% specificity, 46.5% PPV, 82.4% NPV
CURASI: 59.3% sensitivity, 72.8% specificity, 46.4% PPV, 81.8% NPV
CURB-65: 59.3% sensitivity, 75.7% specificity, 49.2% PPV, 82.4% NPV
Validation for the elderly (>65 years):
CURSI: 62.0% sensitivity, 69.4% specificity, 54.4% PPV, 75.6% NPV
CURASI: 60.0% sensitivity, 70.6% specificity, 54.5% PPV, 75.0% NPV
CURB-65: 64.0% sensitivity, 65.9% specificity, 52.5% PPV, 75.7% NPV

Musonda et al. 2011 [32]CARSI, CARASI190 patients76 (median)53NoneDerivation:
CARSI: 40.7% sensitivity, 87.5% specificity, 56.4% PPV, 78.8% NPV, 0.641 area ROC
CARASI: 38.9% sensitivity, 89.0% specificity, 58.3% PPV, 78.6% NPV, 0.639 area ROC
CURB-65: 59.3% sensitivity, 75.7% specificity, 49.2% PPV, 82.4% NPV, 0.675 area ROC

URB: urea, respiratory rate, blood pressure; CRB: confusion, respiratory rate, blood pressure; COUW: confusion, oxygen, urea, white cell count; PPV: positive predictive value; NPV: negative predictive value.