Title
Community-acquired pneumonia severity assessment tools in patients hospitalized with COVID-19: a validation and clinical applicability study
Date Issued
01 July 2021
Access level
metadata only access
Resource Type
journal article
Author(s)
Lazar Neto F.
Marino L.O.
Torres A.
Meirelles Marchini J.F.
Garcia de Alencar J.C.
Palomeque A.
Albacar N.
Brandão Neto R.A.
Souza H.P.
Ranzani O.T.
Bortolotto A.L.
Müller Veiga A.D.
Bellintani A.P.
Fantinatti B.L.
Nicolao B.R.
Caldeira B.T.
Umehara Juck C.E.
Bueno C.G.
Takamune D.J.
Guidotte D.V.
D'Souza E.A.
Oliveira Silva E.C.
Brito Miyaguchi E.T.
Gomes da Silva E.M.
Santos Moreira E.L.
Fonseca e Silva F.M.
de Paula Maroni Escudeiro G.
Travessini G.
Costa G.B.
Tibucheski dos Santos H.
Omori I.H.
Baptista J.M.
Afonso Nascimento J.P.
de Góes Campos L.
Lima L.T.
Boscolo L.
Adsuara Pandolfi M.C.
de Oliveira Silva M.
Sanches M.P.
Saad Menezes M.C.
Gonçalves Cimatti De Calasans M.M.
Lima de Faria M.F.
Bezerra Martins N.A.
Albuquerque de Moura P.
Araújo Simões P.A.
Luna R.B.
Nishiaka R.K.
Miléo R.C.
de Souza Abreu R.
Toccoli R.W.
Monsalvarga T.C.
Brito Medeiros V.M.
Filippo Fernandes Y.S.
Simões A.L.
Tavares A.A.
Carvalho de Alves Pereira C.
Ribeiro D.R.
Dias de Francesco D.
Emerenciano D.L.
Pires de Campos E.M.
Moreira F.L.
Bortoleto F.M.
Martinez G.
Wiebelling da Silva G.
Martins G.B.
Leite Fortes J.C.
Dias Barreto L.G.
Silva de Rosa M.L.
Ursoline do Nascimento M.
Pisciolaro R.F.
Xavier R.A.
Barbosa de Souza S.F.
Lisboa Netto T.A.
Ribeiro S.
Faria C.
Rahhal H.
Padrão E.
Valente F.
Padovan Chio Y.H.
Gomez Gomez L.M.
Universidad de Barcelona
Publisher(s)
Elsevier B.V.
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.
Start page
1037.e1
End page
1037.e8
Volume
27
Issue
7
Language
English
OCDE Knowledge area
Virología
Scopus EID
2-s2.0-85104931335
PubMed ID
Source
Clinical Microbiology and Infection
ISSN of the container
1198743X
Sources of information: Directorio de Producción Científica Scopus