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The Modified APACHE II Score Outperforms Curb65 Pneumonia Severity Score as a Predictor of 30-Day Mortality in Patients With Methicillin-Resistant Staphylococcus aureus Pneumonia^*

^* From the Division of Pulmonary and Critical Care Medicine (Dr. Kollef and Ms. Kollef), Washington University School of Medicine; Center for Quality and Effectiveness (Mr. Reichley), BJC Healthcare; and Department of Pharmacy Practice (Dr. Micek), St. Louis College of Pharmacy, St. Louis, MO.

Correspondence to: Marin H. Kollef, MD, FCCP, Campus Box 8052, Washington University School of Medicine, 660 South Euclid Ave, St. Louis, MO 63110; e-mail: mkollef{at}im.wustl.edu

Abstract

Objective: To compare the predictive accuracy for 30-day mortality of the CURB65 score adopted by the British Thoracic Society and the simpler CRB65 score to APACHE (acute physiology and chronic health evaluation) II in patients with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.

Design: A retrospective, single-center, observational cohort study.

Setting: Barnes-Jewish Hospital, a 1,200-bed urban teaching hospital.

Patients: Adult patients requiring hospitalization identified to have MRSA pneumonia.

Interventions: Retrospective data collection from automated hospital, microbiology, and pharmacy databases.

Measurements and main results: Two hundred eighteen patients with MRSA pneumonia were identified over a 3-year period. Forty-four patients (20.2%) died during hospitalization. All three prediction rules had high negative predictive values but relatively low positive predictive values at most cut-off points examined. APACHE II had the greatest area under the receiver operating characteristic curve (0.805; 95% confidence interval [CI], 0.743 to 0.866) compared to CURB65 (0.634; 95% CI, 0.541 to 0.727) and CRB65 (0.643; 95% CI, 0.546 to 0.739) [p < 0.05 for both comparisons]. Similar results were obtained when the subgroups of community-acquired MRSA pneumonia and health-care–associated MRSA pneumonia were examined separately.

Conclusions: APACHE II outperformed CURB65 and CRB65 for initial prognostic assessment in MRSA pneumonia.

Key Words: APACHE II • CRB65 • CURB65 • methicillin-resistant Staphylococcus aureus • pneumonia

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