Article Data

  • Views 362
  • Dowloads 43

Original Research

Open Access

CRB-65: Predictor for Intensive Care Unit Admission in Patients with Biliary Tract Infection Presenting to An Emergency Department

  • Hansol Yeo1
  • Sung Jin Bae1
  • Yoon Hee Choi1
  • Keon Kim1
  • Jae Hee Lee1

1Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea

DOI: 10.22514/sv.2020.16.0049 Vol.16,Issue 2,October 2020 pp.134-141

Published: 28 October 2020

*Corresponding Author(s): Jae Hee Lee E-mail:

PDF (289.53 kB)


Objectives: Biliary tract infection (BTI) is a common cause of bacteremia and is associated with high morbidity and mortality. However, studies on screening tools to predict disease severity in BTI patients are lacking. This study aimed to comparatively validate CRB, CRB-65, quick Sequential Organ Failure Assessment (qSOFA), and Systemic Inflammatory Response Syndrome (SIRS) in predicting the clinical outcomes of BTI patients. Methods: This retrospective cohort study included patients with BTI who visited the emergency department of a medical center between February 2018 and March 2020. Baseline patient data were compared to assess the prevalence of intensive care unit (ICU) admission and in-hospital mortality. The effectiveness of CRB, CRB-65, qSOFA, and SIRS scores as indicators of ICU admission and in-hospital mortality was evaluated using the area under the receiver operating characteristic (AUROC) curve. Results: This study included 745 patients, of whom 111 (14.8%) were admitted to the ICU and 20 (2.7%) died in-hospital. AUROC values (95% CI) for predicting ICU admission and in-hospital mortality were as follows: CRB, 0.774 and 0.707 (0.742 –0.803 and 0.673 – 0.739); CRB - 65, 0.816 and 0.735 (0.786 – 0.843 and 0.0.702 – 0.766); qSOFA, 0.779 and 0.724 (03747 – 0.808 and 0.690 – 0.755); and SIRS, 0.686 and 0.659 (0.651 – 0.719 and 0.623 – 0.693), respectively. Conclusions: CRB-65 can be used as useful screening tools to predict ICU admission in patients with BTI on presentation to the emergency department.

Key words

Biliary tract infection, Emergency department, CRB-65, CRB, Quick Sequential Organ Failure Assessment

Cite And Share

Hansol Yeo,Sung Jin Bae,Yoon Hee Choi,Keon Kim,Jae Hee Lee. CRB-65: Predictor for Intensive Care Unit Admission in Patients with Biliary Tract Infection Presenting to An Emergency Department. Signa Vitae. 2020. 16(2);134-141.


[1] Shah T, Sterk E, Rech MA. Emergency department sepsis screening tool decreases time to antibiotics in patients with sepsis. Am J Emerg Med. 2018;36:1745-1748.

[2] Melzer M, Toner R, Lacey S, et al. Biliary tract infection and bacteraemia: presentation, structural abnormalities, causative organisms and clinical outcomes. Postgrad Med J. 2007;83:773-776.

[3] Lee C-C, Chang I-J, Lai Y-C, et al. Epidemiology and prognostic determinants of patients with bacteremic cholecystitis or cholangitis. American Journal of Gastroenterology. 2007;102:563-569.

[4] Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama. 2016;315:801-810.

[5] Kolditz M, Scherag A, Rohde G, et al. Comparison of the qSOFA and CRB-65 for risk prediction in patients with community-acquired pneumonia. Intensive Care Med. 2016;42:2108-2110.

[6] Perkins NJ, Schisterman EF. The inconsistency of ”optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve. American journal of epidemiology. 2006;163:670-675.

[7] DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837-845.

[8] Hajian-Tilaki K. Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian journal of internal medicine. 2013;4:627.

[9] Sadaka F, EthmaneAbouElMaali C, Cytron MA, et al. Predicting Mortality of Patients With Sepsis: A Comparison of APACHE II and APACHE III Scoring Systems. J Clin Med Res. 2017;9:907-910.

[10] Lind ML, Phipps AI, Mooney S, et al. Predictive value of three clinical criteria for sepsis (qSOFA, SIRS, and NEWS) with respect to short-term mortality in allogeneic hematopoietic cell transplant recipients with suspected infections. Clin Infect Dis. 2020.

[11] Peres Bota D, Melot C, Lopes Ferreira F, et al. The Multiple Organ Dysfunction Score (MODS) versus the Sequential Organ Failure Assessment (SOFA) score in outcome prediction. Intensive Care Med. 2002;28:1619-1624.

[12] Vincent J-L, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Springer-Verlag; 1996.

[13] Vincent J-L, Martin GS, Levy MM. qSOFA does not replace SIRS in the definition of sepsis. Critical care. 2016;20:1-3.

[14] Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. Jama. 2017;317:290-300.

[15] Haydar S, Spanier M, Weems P, et al. Comparison of QSOFA score and SIRS criteria as screening mechanisms for emergency department sepsis. Am J Emerg Med. 2017;35:1730-1733.

[16] Finkelsztein EJ, Jones DS, Ma KC, et al. Comparison of qSOFA and SIRS for predicting adverse outcomes of patients with suspicion of sepsis outside the intensive care unit. Critical care. 2017;21:73.

[17] Rudd KE, Seymour CW, Aluisio AR, et al. Association of the quick sequential (sepsis-related) organ failure assessment (qSOFA) score with excess hospital mortality in adults with suspected infection in low-and middle-income countries. Jama. 2018;319:2202-2211.

[18] Jiang J, Yang J, Jin Y, et al. Role of qSOFA in predicting mortality of pneumonia: a systematic review and meta-analysis. Medicine. 2018;97:e12634.

[19] Müller M, Guignard V, Schefold JC, et al. Utility of quick sepsis-related organ failure assessment (qSOFA) to predict outcome in patients with pneumonia. PLoS One. 2017;12:e0188913.

[20] Jawa RS, Vosswinkel JA, McCormack JE, et al. Risk assessment of the blunt trauma victim: the role of the quick Sequential Organ Failure Assessment Score (qSOFA). The American Journal of Surgery. 2017;214:397-401.

[21] Singer AJ, Ng J, Thode Jr HC, et al. Quick SOFA scores predict mortality in adult emergency department patients with and without suspected infection. Annals of emergency medicine. 2017;69:475-479.

[22] Brabrand M, Henriksen DP. CURB-65 Score is Equal to NEWS for Identifying Mortality Risk of Pneumonia Patients: An Observational Study. Lung. 2018;196:359-361.

[23] Liu JL, Xu F, Zhou H, et al. Expanded CURB-65: a new score system predicts severity of community-acquired pneumonia with superior efficiency. Sci Rep. 2016;6:22911.

[24] Chalmers JD, Singanayagam A, Akram AR, et al. Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis. Thorax. 2010;65:878-883.

[25] Chalmers JD, Singanayagam A, Akram AR, et al. Safety and efficacy of CURB65-guided antibiotic therapy in community-acquired pneumonia. Journal of Antimicrobial Chemotherapy. 2011;66:416-423.

[26] Yamamoto S, Yamazaki S, Shimizu T, et al. Prognostic utility of serum CRP levels in combination with CURB-65 in patients with clinically suspected sepsis: a decision curve analysis. BMJ open. 2015;5:e007049.

[27] Man SY, Lee N, Ip M, et al. Prospective comparison of three predictive rules for assessing severity of community-acquired pneumonia in Hong Kong. Thorax. 2007;62:348-353.

[28] Chen YX, Wang JY, Guo SB. Use of CRB-65 and quick Sepsis-related Organ Failure Assessment to predict site of care and mortality in pneumonia patients in the emergency department: a retrospective study. Crit Care. 2016;20:167.

[29] Saeed K, Wilson DC, Bloos F, et al. The early identification of disease progression in patients with suspected infection presenting to the emergency department: a multi-centre derivation and validation study. Crit Care. 2019;23:40.

[30] Chen Y-X, Wang J-Y, Guo S-B. Use of CRB-65 and quick Sepsis-related Organ Failure Assessment to predict site of care and mortality in pneumonia patients in the emergency department: a retrospective study. Critical care. 2016;20:167.

[31] Mark K, George N, Bozorgmehri S, et al. 30 qSOFA Outperforms CRB, CRB-65 and CRB-65 Plus: A Multicenter US Observational Study. Annals of emergency medicine. 2017;70:S13.

[32] Su Y, Tu G-w, Ju M-j, et al. Comparison of CRB-65 and quick sepsis related organ failure assessment for predicting the need for intensive respiratory or vasopressor support in patients with COVID-19. J Infect. 2020.

[33] George N, Elie-Turenne M-C, Seethala RR, et al. External Validation of the qSOFA Score in Emergency Department Patients With Pneumonia. The Journal of Emergency Medicine. 2019;57:755-764.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) The Science Citation Index (SCI) is a citation index originally produced by the Institute for Scientific Information (ISI) and created by Eugene Garfield. It (Science Citation Index Expanded) covers more than 8,500 notable and significant journals, across 150 disciplines in science and technology, from 1900 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time