Beyond Traditional Risk Assessment: Evaluating CURB-65 in Diabetic Patients – A Narrative Review
Arati Ambrish Shahade, Chennakesavulu Dara, Veershetty Pasari, Omkaram Siddhardha Varma, K Vaishnavi
Author(s)2Associate Professor, Department of General Medicine, ESIC Medical College & Hospital, Hyderabad, Telangana, India
3Senior Resident, Department of General Medicine, ESIC Medical College & Hospital, Hyderabad, Telangana, India
4Assistant Professor, Department of General Medicine, ESIC Medical College & Hospital, Hyderabad, Telangana, India
Abstract
Background: Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality worldwide. Diabetes mellitus increases susceptibility to CAP and is associated with poorer clinical outcomes. CURB-65 is a widely used severity assessment tool for CAP; however, its prognostic performance in diabetic patients remains uncertain. To evaluate the prognostic performance of CURB-65 in diabetic patients with community-acquired pneumonia and compare its predictive utility with that observed in non-diabetic populations. Material and Methods: A narrative review of literature published between 2015 and 2025 was conducted using PubMed, MEDLINE, and Google Scholar. Studies evaluating CURB-65 in adult CAP patients with diabetes mellitus and reporting mortality or severity outcomes were included. Eleven eligible studies comprising observational, cohort, validation, and prognostic model analyses were synthesized. Results: CURB-65 demonstrated acceptable prognostic performance in diabetic patients, with reported AUC values ranging from 0.67 to 0.75, generally lower than those observed in non-diabetic populations. Sensitivity and specificity were approximately 72.3% and 59.5%, respectively. Increasing CURB-65 scores consistently correlated with higher mortality risk and disease severity. Alternative models, including diabetes-specific nomograms, stress hyperglycemia ratio (SHR), Pneumonia Severity Index (PSI), and biomarker-enhanced scores, showed superior predictive accuracy, with AUC values ranging from 0.81 to 0.91. Conclusion: CURB-65 remains a practical and valuable tool for risk stratification in diabetic patients with CAP; however, its prognostic accuracy is reduced compared with non-diabetic populations. Incorporation of diabetes-related clinical and biochemical parameters may improve outcome prediction and support more individualized risk assessment.
Keywords: Community-acquired pneumonia; CURB-65; Diabetes mellitus; Prognosis; Mortality prediction; Risk stratification.