Community-acquired pneumonia severity assessment tools in patients hospitalized with COVID-19: a validation and clinical applicability study. (July 2021)

• Record Type: Journal Article
• Authors: Lazar Neto, Felippe; Marino, Lucas Oliveira; Torres, Antoni; Cilloniz, Catia; Meirelles Marchini, Julio Flavio; Garcia de Alencar, Julio Cesar; Palomeque, Andrea; Albacar, Núria; Brandão Neto, Rodrigo Antônio; Souza, Heraldo Possolo; Ranzani, Otavio T.; Bortolotto, Alexandre Lemos; Müller Veiga, Alicia Dudy; Bellintani, Arthur Petrillo; Fantinatti, Beatriz Larios; Nicolao, Bianca Ruiz; Caldeira, Bruna Tolentino; Umehara Juck, Carlos Eduardo; Bueno, Cauê Gasparatto; Takamune, Diego Juniti; Guidotte, Diogo Visconti; D'Souza, Edwin Albert; Oliveira Silva, Emily Cristine; Brito Miyaguchi, Erika Thiemy; Gomes da Silva, Ester Minã; Santos Moreira, Everton Luis; Fonseca e Silva, Fernanda Máximo; de Paula Maroni Escudeiro, Gabriel; Travessini, Gabriel; Costa, Giovanna Babikian; Tibucheski dos Santos, Henrique; Omori, Isabela Harumi; Baptista, João Martelleto; Afonso Nascimento, João Pedro; de Góes Campos, Laura; Lima, Ligia Trombetta; Boscolo, Luiza; Adsuara Pandolfi, Manuela Cristina; de Oliveira Silva, Marcelo; Sanches, Marcelo Petrof; Saad Menezes, Maria Clara; Gonçalves Cimatti De Calasans, Mariana Mendes; Lima de Faria, Matheus Finardi; Bezerra Martins, Nilo Arthur; Albuquerque de Moura, Patricia; Araújo Simões, Pedro Antonio; Luna, Rafael Berenguer; Nishiaka, Renata Kan; Miléo, Rodrigo Cezar; de Souza Abreu, Rodrigo; Toccoli, Rodrigo Werner; Monsalvarga, Tales Cabral; Brito Medeiros, Vitor Macedo; Filippo Fernandes, Yasmine Souza; Simões, Ademar Lima; Tavares, Andrew Araujo; Carvalho de Alves Pereira, Clara; Ribeiro, Daniel Rodrigues; Dias de Francesco, Danilo; Emerenciano, Debora Lopes; Pires de Campos, Eduardo Mariani; Moreira, Felipe Liger; Bortoleto, Felipe Mouzo; Martinez, Gabriel; Wiebelling da Silva, Geovane; Martins, Gustavo Biz; Leite Fortes, Julio Cesar; Dias Barreto, Lucas Gonçalves; Silva de Rosa, Maria Lorraine; Ursoline do Nascimento, Mauricio; Pisciolaro, Rafael Faria; Xavier, Rodolfo Affonso; Barbosa de Souza, Stefany Franhan; Lisboa Netto, Thiago Areas; Ribeiro, Sabrina; Faria, Carine; Rahhal, Hassam; Padrão, Eduardo; Valente, Fernando; Padovan Chio, Yago Henrique; Gomez Gomez, Luz Marina;
• Is Part Of: Clinical microbiology and infection. Volume 27:Number 7(2021)
• Page Start: 1037.e1
• Page End: 1037.e8
• Publication Date: 2021-07
• Subjects: Coronavirus -- Coronavirus disease 2019 -- Mortality -- Pneumonia -- Prediction -- Prognosis -- Severity -- Validation; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2021.03.002
• Languages: English
• ISSNs: 1198-743X

Abstract

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.