COMPREHENSIVE ASSESSMENT OF CURB-65 SCORE IN RESPIRATORY DISTRESS: PREDICTIVE INSIGHTS INTO CLINICAL OUTCOMES AND MORTALITY RISK
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Keywords
Blood lactate levels, Community-acquired pneumonia, CURB-65 severity score
Abstract
Background: Community-acquired pneumonia (CAP) remains a major public health concern globally, with a significant impact on mortality, particularly in developing nations such as India.
Aim: This study prospectively evaluates the predictive efficacy of blood lactate levels and the CURB-65 score in Community-Acquired Pneumonia (CAP) patients upon Emergency Department admission., filling a critical gap in understanding CAP prognosis in the Indian population.
Methodology: This prospective observational study was conducted at a tertiary care hospital and included 90 consecutive adults (age >18 years) presenting to the emergency department with clinically diagnosed community-acquired pneumonia (CAP). Exclusions comprised individuals with hospital-acquired pneumonia, aspiration pneumonia, septic shock at presentation, chronic liver or kidney disease, or those referred/discharged pre-admission. Data encompassed comprehensive patient details, vital signs, lab results, and CURB-65 score. Admission blood lactate levels were categorized into three groups. Comparative analyses included clinical features, site of care, duration, and mortality rates, applying appropriate statistical tests. Significance was set at P<0.05.
Results: This study of 90 CAP patients revealed that historical features, comorbidities, and clinical parameters significantly varied across CURB-65 classes. Haemoglobin, blood sugar, and blood urea demonstrated class-specific associations. CURB-65 showed limited predictive accuracy for ICU admission but a significant correlation with mortality. Blood lactate, particularly in higher groups, exhibited strong correlations with outcomes. A blood lactate cutoff of >3.45 mmol/L predicted ICU admission and mortality with higher sensitivity than CURB-65. These findings underscore the potential of blood lactate as a prognostic marker in CAP.
Conclusion: Incorporating blood lactate measurements, especially for those deemed low or intermediate risk by CURB-65, enhances sensitivity and risk stratification accuracy. While CURB-65 retains significance, our results endorse the combined use of blood lactate levels for a more nuanced and accurate clinical evaluation of community-acquired pneumonia patients.
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Dr. Deepak T. G.
Associate Professor, Department of Emergency Medicine, Shridevi Institute of Medical Sciences and Research Hospital, Tumakuru, Karnataka, India.
Dr. Raveesh P. M.
Associate Professor, Department of Community Medicine, Shridevi Institute of Medical Sciences and Research Hospital, Tumakuru, Karnataka, India.
Dr. Manju M. D.
Associate Professor, Department of Respiratory Medicine, Shridevi Institute of Medical Sciences and Research Hospital, Tumakuru, Karnataka, India.
Dr. Prakash B.
Associate Professor, Department of Emergency Medicine, Shridevi Institute of Medical Sciences and Research Hospital, Tumakuru, Karnataka, India.
Dr. Prathibha K. T.
Associate Professor, Department of Anesthesia, Shridevi Institute of Medical Sciences and Research Hospital, Tumakuru, Karnataka, India.