ASSESS THE FACTORS PREDICTING OUTCOMES IN COMMUNITY ACQUIRED PNEUMONIA IN AN TERTIARY CARE SETTING AND COMPARISON BETWEEN CURB-65 AND PSI-SCORE

BackgroundBackground: Pneumonia is an acute inflammation of the pulmonary parenchyma caused by various infective organisms. Mortality rate of pneumonia is very high. Severity assessment is recognised as a pivotal step in the management of CAP. This study was intended in identifying prognostic factors to predict mortality in CAP and comparison between CURB-65 and PSI-SCORE Methods: It was a prospective, observational, cohort study, which include 150 cases of CAP selected for a period of two years. All Laboratory examination including complete blood counts, blood glucose, renal function tests, liver function tests, blood gas analysis, HIV ELISA, blood culture and Chest radiology were done. The scores of PSI and CURB-65 were calculated for all patients. The final outcomes: ICU admission, need for invasive mechanical ventilation and hospital mortality were compared. Results: One hundred and fifty patients were included at the age ranged from 14 to 90 years with a mean age of 58.8 ± 15.73 years. The majorities (60%) of the patients were males and 40% were females. Out of 150 patients, 90(60%) were admitted to general wards and 60(40%) were admitted to the ICU. Out of the 60 patients admitted to the ICU, 45(75%) required Mechanical Ventilation. Clinical correlation of six classes of CURB-65 Score was described. In Class-0,there was 5 patients and none of them were admitted in ICU or required MV or expired. In class-1, out of 69 patients, 19 (27.53%) were admitted in ICU, 10(14.49%)required MV and 3(4.35%) expired. In Class-2,amongst 57 patients, 22(38.6%) admitted to the ICU, 16(28.07%) required MV and 4(7.01%) expired. In Class-3 , all nine patients (/100%) required ICU admission and MV and 4(44.44%) died. In Class-4, there was 7 cases, all of these patients were admitted to ICU and required MV amongst which 4 cases (57.14%) expired. In Class-5, there were 3 cases, all of these patients were hemodynamically unstable, admitted to ICU and put on MV but none of them survived. The clinical correlation of the 150 patients with the five classes of PSI-Score was done In ClassI, there was no death out of 3 patients. In Class-II, 15 patients and 4 (26.67%) cases were admitted in ICU. In Class-III,there was 25 patients out of which 7(28%) required ICU admission, 4 (16% )required MV and 2 (8%)expired. In Class-IV, out of 72 cases, 21(29.16%) were admitted to the ICU, and 15 (20.83%) required MV amongst which 6(8.33%) expired. There were 35 cases in Class-V, 28(80%) of cases required ICU admission and 24 patients (68.57%) required MV and 9 (25.71) expired. Highest ICU admission was seen in PSI class> IV and CURB-65class->2.The sensitivity of predicting ICU admission of PSI class >IV was 31.58% and specificity was 90.91% . The sensitivity of CURB-65 class->2 was 15.79% and specificity was 100%. Thus, CURB-65 class >2 had more specificity for predicting ICU admissions whereas PSI class >IV had more sensitivity. Conclusion: In conclusion, both PSI and CURB-65 have comparable accuracy to predict outcome from CAP. Mortality rates progressively increase with increasing risk class in both severity scoring systems.