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Multicenter Study
. 2021 May;36(5):1338-1345.
doi: 10.1007/s11606-021-06626-7. Epub 2021 Feb 11.

Severity Scores in COVID-19 Pneumonia: a Multicenter, Retrospective, Cohort Study

Arturo Artero  1 , Manuel Madrazo  2 , Mar Fernández-Garcés  3 , Antonio Muiño Miguez  4 , Andrés González García  5 , Anxela Crestelo Vieitez  6 , Elena García Guijarro  7 , Eva María Fonseca Aizpuru  8 , Miriam García Gómez  9 , María Areses Manrique  10 , Carmen Martinez Cilleros  11 , María Del Pilar Fidalgo Moreno  12 , José Loureiro Amigo  13 , Ricardo Gil Sánchez  14 , Elisa Rabadán Pejenaute  15 , Lucy Abella Vázquez  16 , Ruth Cañizares Navarro  17 , Marta Nataya Solís Marquínez  18 , Francisco Javier Carrasco Sánchez  19 , Julio González Moraleja  20 , Lorena Montero Rivas  21 , Joaquín Escobar Sevilla  22 , María Dolores Martín Escalante  23 , Ricardo Gómez-Huelgas  24 , José Manuel Ramos-Rincón  25 ; SEMI-COVID-19 Network
Affiliations
Multicenter Study

Severity Scores in COVID-19 Pneumonia: a Multicenter, Retrospective, Cohort Study

Arturo Artero et al. J Gen Intern Med. 2021 May.

Abstract

Background: Identification of patients on admission to hospital with coronavirus infectious disease 2019 (COVID-19) pneumonia who can develop poor outcomes has not yet been comprehensively assessed.

Objective: To compare severity scores used for community-acquired pneumonia to identify high-risk patients with COVID-19 pneumonia.

Design: PSI, CURB-65, qSOFA, and MuLBSTA, a new score for viral pneumonia, were calculated on admission to hospital to identify high-risk patients for in-hospital mortality, admission to an intensive care unit (ICU), or use of mechanical ventilation. Area under receiver operating characteristics curve (AUROC), sensitivity, and specificity for each score were determined and AUROC was compared among them.

Participants: Patients with COVID-19 pneumonia included in the SEMI-COVID-19 Network.

Key results: We examined 10,238 patients with COVID-19. Mean age of patients was 66.6 years and 57.9% were males. The most common comorbidities were as follows: hypertension (49.2%), diabetes (18.8%), and chronic obstructive pulmonary disease (12.8%). Acute respiratory distress syndrome (34.7%) and acute kidney injury (13.9%) were the most common complications. In-hospital mortality was 20.9%. PSI and CURB-65 showed the highest AUROC (0.835 and 0.825, respectively). qSOFA and MuLBSTA had a lower AUROC (0.728 and 0.715, respectively). qSOFA was the most specific score (specificity 95.7%) albeit its sensitivity was only 26.2%. PSI had the highest sensitivity (84.1%) and a specificity of 72.2%.

Conclusions: PSI and CURB-65, specific severity scores for pneumonia, were better than qSOFA and MuLBSTA at predicting mortality in patients with COVID-19 pneumonia. Additionally, qSOFA, the simplest score to perform, was the most specific albeit the least sensitive.

Keywords: COVID-19; CURB-65; PSI; community-acquired pneumonia; qSOFA.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patients included from the SEMI-COVID-19 Network with COVID-19 pneumonia. COVID-19: coronavirus infectious disease 2019.
Figure 2
Figure 2
Receiver operating characteristic curves for PSI, CURB65, MuLBSTA, and qSOFA scores for in-hospital mortality in COVID19 pneumonia patients. PSI: Pneumonia Severity Index; CURB-65: Confusion, Urea, Respiratory rate, Blood pressure, and age ≥65 years; MuLBSTA: Multilobar infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension and Age; qSOFA: quick Sequential Organ Failure Assessment; COVID-19: coronavirus infectious disease 2019.
See this image and copyright information in PMC

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