CRB-65 predicts death from community-acquired pneumonia

J Intern Med. 2006 Jul;260(1):93-101. doi: 10.1111/j.1365-2796.2006.01657.x.


Objective: The study was performed to validate the CURB, CRB and CRB-65 scores for the prediction of death from community-acquired pneumonia (CAP) in both the hospital and out-patient setting.

Design: Data were derived from a large multi-centre prospective study initiated by the German competence network for community-acquired pneumonia (CAPNETZ) which started in March 2003 and were censored for this analysis in October 2004.

Setting: Out- and in-hospital patients in 670 private practices and 10 clinical centres.

Subjects: Analysis was done for n = 1343 patients (n = 208 out-patients and n = 1135 hospitalized) with all data sets completed for the calculation of CURB and repeated for n = 1967 patients (n = 482 out-patients and n = 1485 hospitalized) with complete data sets for CRB and CRB-65.

Intervention: None. 30-day mortality from CAP was determined by personal contacts or a structured interview.

Results: Overall 30-day mortality was 4.3% (0.6% in out-patients and 5.5% in hospitalized patients, P < 0.0001). Overall, the CURB, CRB and CRB-65 scores provided comparable predictions for death from CAP as determined by receiver-operator-characteristics (ROC) curves. However, in hospitalized patients, CRB misclassified 26% of deaths as low risk patients. Availability of the CRB-65 score (90%) was far superior to that of CURB (65%), due to missing blood urea nitrogen values (P < 0.001).

Conclusions: Both the CURB and CRB-65 scores can be used in the hospital and out-patients setting to assess pneumonia severity and the risk of death. Given that the CRB-65 is easier to handle, we favour the use of CRB-65 where blood urea nitrogen is unavailable.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Urea Nitrogen
  • Community-Acquired Infections / mortality
  • Decision Making
  • Female
  • Germany / epidemiology
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Outpatient Clinics, Hospital
  • Pneumonia / mortality*
  • Prognosis
  • Prospective Studies
  • ROC Curve
  • Risk Factors
  • Severity of Illness Index*