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

Autor(es):Mostrar menos -

Neto, Felippe Lazar ^[1] ; Marino, Lucas Oliveira ^[1] ; Torres, Antoni ^[2] ; Cilloniz, Catia ^{[3, 2]} ; Meirelles Marchini, Julio Flavio ^[1] ; Garcia de Alencar, Julio Cesar ^[1] ; Palomeque, Andrea ^{[3, 2]} ; Albacar, Nuria ^{[3, 2]} ; Brandao Neto, Rodrigo Antonio ^[1] ; Souza, Heraldo Possolo ^[1] ; Ranzani, Otavio T. ^{[4, 5]} ; Team, COVID Registry

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo FMUSP, Emergency Med Dept, Fac Med, Ave Dr Eneas Carvalho de Aguiar 255, Sao Paulo - Brazil

^[2] Univ Barcelona, Hosp Clin Barcelona, Biomed Res Networking Ctr Resp Dis CIBERES, CIBERE, Dept Pneumol, August Pi i Sunyer Biomed Res Inst I, Barcelona - Spain

^[3] Catalan Inst Res & Adv Studies ICREA, Barcelona - Spain

^[4] ISGlobal, Barcelona Inst Global Hlth, Barcelona - Spain

^[5] Univ Sao Paulo, Hosp Clin HCFMUSP, Fac Med, Pulm Div, Heart Inst InCor, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: Clinical Microbiology and Infection; v. 27, n. 7 JUL 2021.
• Citações Web of Science: 1

Resumo

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 Sao Paulo and Barcelona: Pneumonia Severity Index (PSI), CURB, CURB-65, qS0FA, 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 Sao 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. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. (AU)

• Processo FAPESP: 20/04738-8 - Pacientes com Síndrome Respiratória Aguda Grave por COVID-19 em serviço de emergência
• Beneficiário: Heraldo Possolo de Souza
• Modalidade de apoio: Auxílio à Pesquisa - Regular