Viral prevalence, clinical profiles and comparison of severity scores for predicting the mortality of adults with severe acute respiratory infections

Abstract

Background/aim: The aim of this study was to determine the accuracy of severity scores for predicting the 28-day mortality among adults with severe acute respiratory infection (SARI) admitted to the emergency department.

Materials and methods: This study included 159 consecutive adult patients with SARI admitted to the emergency department of a tertiary hospital. A standard form was filled out in order to record demographic information, clinical parameters, laboratory tests, and radiographic findings of the patients. CURB-65, PSI, SIRS, qSOFA, SOFA and APACHE II scores were compared between the survivor and nonsurvivor groups.

Results: Of 159 patients included in the study, 38.4% were positive for respiratory viruses and 28.3% were positive for influenza viruses. 35.8% of the patients were admitted to an intensive care unit (ICU) and the mortality rate was 36.5%. The area under the receiver operating characteristic curve of CURB-65, PSI, SIRS criteria, qSOFA, SOFA and APACHE II scores were 0.717, 0.712, 0.607, 0.683, 0.755, and 0.748, respectively in predicting mortality and 0.759, 0.744, 0.583, 0.728, 0.741, and 0.731, respectively in predicting ICU admission.

Conclusion: SOFA and APACHE II were more accurate than SIRS in predicting the 28-day mortality among adults with SARI. There was no significant difference among these scores in terms of other multivariate comparisons.

Keywords: Severe acute respiratory infection; severity scores; influenza viruses.

Figure 1

Patient flowchart.

Figure 2

Area under the receiver operating characteristic (AUROC) curve. APACHE II: acute physiology and chronic health evaluation 2, CURB65: confusion, urea >7 mmol/l, respiratory rate 30/min, low systolic (< 90 mmHg) or diastolic blood pressure (≤ 60 mmHg) and age 65 years, PSI: pneumonia severity index; SIRS: systemic inflammatory response syndrome, SOFA: sequential (sepsis-related) organ failure assessment, qSOFA: quick SOFA scores for predicting intensive care unit (ICU) admission and for predicting mortality in patients with severe acute respiratory infection (SARI).