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Updated: Oct 2, 2025
Experimental Model to Evaluate Resolution of Pneumonia
Published on: February 17, 2023
Usefulness of CURB-65, pneumonia severity index and MuLBSTA in predicting COVID-19 mortality
Carlo Preti1, Roberta Biza2, Luca Novelli3
1Emergency Department, ASST Papa Giovanni XXIII, Bergamo. carlo.preti@unimi.it.
Abstract:
The aim of our study is to evaluate the accuracy of CURB-65 and Pneumonia Severity Index (PSI), the most widely used scores for community acquired pneumonia, and MuLBSTA, a viral pneumonia score, in predicting 28-day mortality in Coronavirus Disease 2019 (COVID-19) pneumonia.We retrospectively collected clinical data of consecutive patients with laboratory-confirmed COVID-19 pneumonia admitted at Papa Giovanni XXIII Hospital from February 23rd to March 14th, 2020. We calculated at Emergency Department (ED) presentation CURB-65, PSI and MuLBSTA and we compared their performances in discriminating between survivors and non-survivors at 28 days. Among 431 hospitalized patients, the majority presented with hypoxic respiratory failure: median (interquartile range, IQR) PaO2/FiO2 ratio at admission was 228.6 (142.0-278.1). In the first 24 hours, 111 (27%) patients were administered low-flow oxygen cannula, 50 (12%) Venturi Mask, 95 (23%) non-rebreather mask, 106 (26%) non-invasive ventilation, 12 (3%) mechanical ventilation and 41 (9%) were not administered oxygen therapy. Mortality rate at 28-day was 35% (150/431). Between survivors and non-survivors, median (IQR) scores were, respectively, 1.0 (1.0-2.0) and 2.0 (2.0-3.0) for CURB-65 (p<0.001); 90.5 (76.0-105.5) and 115.0 (100.0-129.0) for PSI (p<0.001); 7.0 (5.0-10.0) and 11.0 (9.0-13.0) for MuLBSTA (p<0.001). Areas under the receiver operating characteristic curve (AUCs) for each score were, respectively, 0.725 (0.662-0.787), 0.776 (0.693-0.859) and 0.743 (0.680-0.806) (p>0,05). PSI and MuLBSTA did not show a better performance when compared to CURB-65. Although CURB-65, PSI and MuLBSTA scores are useful tools to discriminate between survivors and non-survivors in COVID-19 pneumonia, their diagnostic accuracy in discriminating 28-day mortality in COVID-19 pneumonia is moderate, as confirmed by AUCs <0.80, and there is a potential underestimation of disease severity in the low-risk classes. For this reason, they should not be recommended in ED to decide between inpatient and outpatient management in patients affected by COVID-19 pneumonia.
Insights
Community-acquired pneumonia scores like CURB-65, PSI, and MuLBSTA show moderate accuracy in predicting COVID-19 pneumonia mortality. These scores may underestimate severity, and are not recommended for inpatient vs. outpatient decisions in the ED.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Community-acquired pneumonia (CAP) scoring systems are vital for patient management.
- Coronavirus Disease 2019 (COVID-19) pneumonia presents unique challenges in severity assessment.
- Existing CAP scores require evaluation for their efficacy in COVID-19 contexts.
Purpose of the Study:
- To assess the accuracy of CURB-65, Pneumonia Severity Index (PSI), and MuLBSTA in predicting 28-day mortality in COVID-19 pneumonia.
- To compare the performance of these scores in discriminating between survivors and non-survivors.
- To determine the utility of these scores in emergency department (ED) decision-making for COVID-19 patients.
Main Methods:
- Retrospective collection of clinical data from 431 laboratory-confirmed COVID-19 pneumonia patients.
- Calculation of CURB-65, PSI, and MuLBSTA scores at Emergency Department (ED) presentation.
- Comparison of score performance using receiver operating characteristic (ROC) curve analysis to evaluate 28-day mortality prediction.
Main Results:
- The 28-day mortality rate was 35% (150/431).
- All three scores (CURB-65, PSI, MuLBSTA) showed statistically significant differences between survivors and non-survivors (p<0.001).
- Areas under the ROC curve (AUCs) were moderate (0.725 for CURB-65, 0.776 for PSI, 0.743 for MuLBSTA), indicating limited diagnostic accuracy.
Conclusions:
- CURB-65, PSI, and MuLBSTA scores have moderate accuracy in predicting 28-day mortality for COVID-19 pneumonia.
- These scores may underestimate disease severity, particularly in low-risk groups.
- The scores are not recommended for ED decisions regarding inpatient versus outpatient management of COVID-19 pneumonia patients.
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