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Comparative Study
. 2021 Jul;27(7):1037.e1-1037.e8.
doi: 10.1016/j.cmi.2021.03.002. Epub 2021 Apr 2.

Community-acquired pneumonia severity assessment tools in patients hospitalized with COVID-19: a validation and clinical applicability study

Felippe Lazar Neto  1 , Lucas Oliveira Marino  2 , Antoni Torres  3 , Catia Cilloniz  4 , Julio Flavio Meirelles Marchini  2 , Julio Cesar Garcia de Alencar  2 , Andrea Palomeque  4 , Núria Albacar  4 , Rodrigo Antônio Brandão Neto  2 , Heraldo Possolo Souza  2 , Otavio T Ranzani  5 ; COVID Registry Team; Medical Students; Residents; Attending physicians
Collaborators, Affiliations
Comparative Study

Community-acquired pneumonia severity assessment tools in patients hospitalized with COVID-19: a validation and clinical applicability study

Felippe Lazar Neto et al. Clin Microbiol Infect. 2021 Jul.

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Coronavirus; Coronavirus disease 2019; Mortality; Pneumonia; Prediction; Prognosis; Severity; Validation.

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Figures

Fig. 1
Fig. 1
Mortality rates by pneumonia risk assessment tools stratification at admission. Asterisk marks values in the x-axis described as percentages.
Fig. 2
Fig. 2
Decision curve analysis.
See this image and copyright information in PMC

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