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Community-acquired pneumonia severity assessment tools in patients hospitalized with COVID-19: a validation and clinical applicability study
Clinical microbiology and infection, 2021-07, Vol.27 (7), p.1037.e1-1037.e8
2021
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Autor(en) / Beteiligte
Titel
Community-acquired pneumonia severity assessment tools in patients hospitalized with COVID-19: a validation and clinical applicability study
Ist Teil von
  • Clinical microbiology and infection, 2021-07, Vol.27 (7), p.1037.e1-1037.e8
Ort / Verlag
England: Elsevier Ltd
Erscheinungsjahr
2021
Quelle
Alma/SFX Local Collection
Beschreibungen/Notizen
  • To externally validate community-acquired pneumonia (CAP) tools on patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia from two distinct countries, and compare their performance with recently developed COVID-19 mortality risk stratification tools. We evaluated 11 risk stratification scores in a binational retrospective cohort of patients hospitalized with COVID-19 pneumonia in São Paulo and Barcelona: Pneumonia Severity Index (PSI), CURB, CURB-65, qSOFA, Infectious Disease Society of America and American Thoracic Society Minor Criteria, REA-ICU, SCAP, SMART-COP, CALL, COVID GRAM and 4C. The primary and secondary outcomes were 30-day in-hospital mortality and 7-day intensive care unit (ICU) admission, respectively. We compared their predictive performance using the area under the receiver operating characteristics curve (AUC), sensitivity, specificity, likelihood ratios, calibration plots and decision curve analysis. Of 1363 patients, the mean (SD) age was 61 (16) years. The 30-day in-hospital mortality rate was 24.6% (228/925) in São Paulo and 21.0% (92/438) in Barcelona. For in-hospital mortality, we found higher AUCs for PSI (0.79, 95% CI 0.77–0.82), 4C (0.78, 95% CI 0.75–0.81), COVID GRAM (0.77, 95% CI 0.75–0.80) and CURB-65 (0.74, 95% CI 0.72–0.77). Results were similar for both countries. For the 1%–20% threshold range in decision curve analysis, PSI would avoid a higher number of unnecessary interventions, followed by the 4C score. All scores had poor performance (AUC <0.65) for 7-day ICU admission. Recent clinical COVID-19 assessment scores had comparable performance to standard pneumonia prognostic tools. Because it is expected that new scores outperform older ones during development, external validation studies are needed before recommending their use.
Sprache
Englisch
Identifikatoren
ISSN: 1198-743X
eISSN: 1469-0691
DOI: 10.1016/j.cmi.2021.03.002
Titel-ID: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8016546
Format
–
Schlagworte
Coronavirus, Coronavirus disease 2019, Mortality, Original, Pneumonia, Prediction, Prognosis, Severity, Validation

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