tetano
Editor, Senior Moderator
Clin Microbiol Infect
. 2021 Apr 1;S1198-743X(21)00136-1.
doi: 10.1016/j.cmi.2021.03.002. Online ahead of print.
Community-acquired Pneumonia Severity Assessment Tools in Patients Hospitalized with COVID-19: a Validation and Clinical Applicability Study
Felippe Lazar Neto[SUP] 1 [/SUP], Lucas Oliveira Marino[SUP] 2 [/SUP], Antoni Torres[SUP] 3 [/SUP], Catia Cilloniz[SUP] 3 [/SUP], Julio Flavio Meirelles Marchini[SUP] 2 [/SUP], Julio Cesar Garcia de Alencar[SUP] 2 [/SUP], Andrea Palomeque[SUP] 3 [/SUP], N?ria Albacar[SUP] 3 [/SUP], Rodrigo Ant?nio Brand?o Neto[SUP] 2 [/SUP], Heraldo Possolo Souza[SUP] 2 [/SUP], Otavio T Ranzani[SUP] 4 [/SUP], COVID Registry Team
Collaborators, Affiliations
Abstract
Objective: To externally validate community acquired pneumonia (CAP) tools on patients hospitalized with COVID-19 pneumonia from two distinct countries, and compare its performance to 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 S?o 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 seven-day intensive-care unit (ICU) admission respectively. We compared their predictive performance using the area under the ROC curve (AUROC), 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 S?o Paulo and 21.0% (92/438) in Barcelona. For in-hospital mortality, we found higher AUROCs 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 most 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 (AUROC<0.65) for seven-day ICU admission.
Conclusions: Recent clinical COVID-19 assessment scores had comparable performance to standard pneumonia assessment tools. Because it is expected that new scores outperform older ones during development, external validation studies are needed before recommending their use.
Keywords: COVID-19; coronavirus; mortality; pneumonia; prediction; prognosis; severity; validation.
. 2021 Apr 1;S1198-743X(21)00136-1.
doi: 10.1016/j.cmi.2021.03.002. Online ahead of print.
Community-acquired Pneumonia Severity Assessment Tools in Patients Hospitalized with COVID-19: a Validation and Clinical Applicability Study
Felippe Lazar Neto[SUP] 1 [/SUP], Lucas Oliveira Marino[SUP] 2 [/SUP], Antoni Torres[SUP] 3 [/SUP], Catia Cilloniz[SUP] 3 [/SUP], Julio Flavio Meirelles Marchini[SUP] 2 [/SUP], Julio Cesar Garcia de Alencar[SUP] 2 [/SUP], Andrea Palomeque[SUP] 3 [/SUP], N?ria Albacar[SUP] 3 [/SUP], Rodrigo Ant?nio Brand?o Neto[SUP] 2 [/SUP], Heraldo Possolo Souza[SUP] 2 [/SUP], Otavio T Ranzani[SUP] 4 [/SUP], COVID Registry Team
Collaborators, Affiliations
- PMID: 33813111
- DOI: 10.1016/j.cmi.2021.03.002
Abstract
Objective: To externally validate community acquired pneumonia (CAP) tools on patients hospitalized with COVID-19 pneumonia from two distinct countries, and compare its performance to 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 S?o 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 seven-day intensive-care unit (ICU) admission respectively. We compared their predictive performance using the area under the ROC curve (AUROC), 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 S?o Paulo and 21.0% (92/438) in Barcelona. For in-hospital mortality, we found higher AUROCs 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 most 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 (AUROC<0.65) for seven-day ICU admission.
Conclusions: Recent clinical COVID-19 assessment scores had comparable performance to standard pneumonia assessment tools. Because it is expected that new scores outperform older ones during development, external validation studies are needed before recommending their use.
Keywords: COVID-19; coronavirus; mortality; pneumonia; prediction; prognosis; severity; validation.