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. 2019 Aug 15;14(8):e0219367.
doi: 10.1371/journal.pone.0219367. eCollection 2019.

The change in age distribution of CAP population in Korea with an estimation of clinical implications of increasing age threshold of current CURB65 and CRB65 scoring system

Byunghyun Kim  1 , Joonghee Kim  1 , You Hwan Jo  1 , Jae Hyuk Lee  1 , Ji Eun Hwang  1
Affiliations

The change in age distribution of CAP population in Korea with an estimation of clinical implications of increasing age threshold of current CURB65 and CRB65 scoring system

Byunghyun Kim et al. PLoS One. .

Abstract

Background: CURB65 and CRB65 score are simple and popular methods to estimate the mortality in patients with community-acquired pneumonia (CAP). Although there has been a global increase in life expectancy and population ageing, we are still using the same age threshold derived from patients in late 1990s to calculate the scores. We sought to assess the implication of using higher age threshold using Korean population data and a single center hospital records.

Methods: Using Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC), we analyzed annual age distribution of CAP patients in Korea from 2005 to 2013 and report how patients aged >65 years increased over time. We also assessed annual change in test characteristics of various age threshold in Korean CAP population. Using a single center hospital registry of CAP patients (2008-2017), we analyzed test characteristics of CURB65 and CRB65 scores with various age thresholds.

Results: 116,481 CAP cases were identified from NHIS-NSC dataset. The proportion of patients aged >65 increased by 1.01% (95% CI, 0.70%-1.33%, P<0.001) every year. In the sample Korean population dataset, age threshold showed its peak AUROC (0.829) at 70. In the hospital dataset, 7,197 cases were included for analysis. The AUROC of both CRB65 and CURB65 was maximized at 71. When CRB71 was applied instead of CRB65 for hospital referral using score <1 to define a low-risk case, the potential hospital referral was significantly decreased (72.9% to 64.6%, P<0.001) without any significant increase in 1-month mortality in the low risk group (0.6% to 0.7%, P = 0.690).

Conclusion: There was a significant age shift in CAP population in Korea. Increasing the current age threshold of CURB65 (or CRB65) could be a viable option to reduce ever-increasing hospital referrals and admissions of CAP patients.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Annual age distribution of CAP patients in NHIS-NSC cohort.
Fig 2
Fig 2. Sensitivity analysis of NHIS-NSC cohort with changing the age threshold.
AUC, area under the receiver operating characteristic curve; PPV, positive predictive value; NPV, negative predictive value. The 95% confidence intervals for each point are shown as vertical lines.
Fig 3
Fig 3. Annual trend in sensitivity, specificity, PPV and NPV of the current and alternative age thresholds in NHIS-NSC cohort.
PPV, positive predictive value; NPV, negative predictive value. The 95% confidence intervals for each point are shown as shaded areas.
See this image and copyright information in PMC

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