From the Guidelines
CURB-65 is a clinical prediction rule used to assess the severity of community-acquired pneumonia, evaluating Confusion, Urea, Respiratory rate, Blood pressure, and age ≥65 years, with a score of 0-5 determining the need for hospital admission or outpatient treatment. The acronym stands for the five criteria evaluated: Confusion (new-onset), Urea (blood urea nitrogen) >7 mmol/L (>19 mg/dL), Respiratory rate ≥30 breaths per minute, Blood pressure (systolic <90 mmHg or diastolic ≤60 mmHg), and age ≥65 years. Each criterion is assigned one point, creating a score from 0-5.
Key Points
- Patients scoring 0-1 are considered low risk and can typically be treated as outpatients 1.
- Those scoring 2 should be considered for short hospital stays or supervised outpatient treatment 1.
- Patients with scores of 3-5 have higher mortality risk and generally require hospitalization, with scores of 4-5 often indicating need for intensive care unit admission 1.
- CURB-65 helps standardize clinical decision-making by objectively quantifying pneumonia severity, though it should complement rather than replace clinical judgment 1.
- The parameters reflect physiological stress, organ dysfunction, and age-related vulnerability that correlate with poorer outcomes in pneumonia patients.
Comparison with Other Criteria
- The CURB-65 score is compared to the Pneumonia Severity Index (PSI) in terms of predicting mortality and guiding admission decisions 1.
- While the PSI includes 20 different variables, the CURB-65 criteria are easily remembered and have been shown to be effective in determining the need for hospital admission 1.
From the Research
Definition of CURB-65
- CURB-65 is a clinical prediction rule used to stratify patients with pneumonia by expected mortality 2
- It assesses the following parameters:
- Confusion
- Uremia (elevated blood urea nitrogen)
- Respiratory rate (≥ 30/min)
- Blood pressure (low, systolic < 90 mmHg or diastolic ≤ 60 mmHg)
- Age (≥ 65 years)
Components and Scoring
- Each parameter is assigned a point, and the total score ranges from 0 to 5 3
- The score is used to predict the severity of community-acquired pneumonia (CAP) and guide management decisions
Comparison with Other Scoring Systems
- CURB-65 has been compared to other scoring systems, such as A-DROP and PSI, and has been shown to be a useful tool for predicting mortality and severity of CAP 4, 3
- The expanded CURB-65 score, which includes additional parameters such as LDH and albumin levels, has been shown to have superior predictive efficiency compared to the original CURB-65 score 4
Clinical Application
- CURB-65 can be used to identify patients with CAP who are at low risk of mortality and may be suitable for outpatient treatment 5
- The score can also be used to predict the need for critical care interventions, such as ICU admission and mechanical ventilation 2
- A new scoring system, CURBS-65, which includes oxygenation parameters, has been proposed as a potential improvement over the original CURB-65 score 6