1. Community-acquired pneumonia severity assessment tools in patients hospitalized with COVID-19: a validation and clinical applicability study
- Author
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Hassam Rahhal, Maria Lorraine Silva de Rosa, Manuela Cristina Adsuara Pandolfi, Yago Henrique Padovan Chio, Cauê Gasparatto Bueno, Andrea Palomeque, Rodrigo Cezar Miléo, Erika Thiemy Brito Miyaguchi, Danilo Dias de Francesco, Julio Cesar Leite Fortes, Marcelo Petrof Sanches, Thiago Areas Lisboa Netto, Clara Carvalho de Alves Pereira, Diego Juniti Takamune, Matheus Finardi Lima de Faria, Patricia Albuquerque de Moura, Sabrina Ribeiro, Beatriz Larios Fantinatti, Otavio T. Ranzani, Rodolfo Affonso Xavier, Fernando Valente, Diogo Visconti Guidotte, Nilo Arthur Bezerra Martins, Giovanna Babikian Costa, Eduardo Padrão, Gabriel Martinez, Nuria Albacar, Antoni Torres, Heraldo Possolo de Souza, Daniel Rodrigues Ribeiro, Lucas Oliveira Marino, Gabriel de Paula Maroni Escudeiro, Rafael Faria Pisciolaro, Debora Lopes Emerenciano, Rafael Berenguer Luna, Emily Cristine Oliveira Silva, Isabela Harumi Omori, Catia Cilloniz, Edwin Albert D'Souza, Rodrigo Werner Toccoli, Everton Luis Santos Moreira, Yasmine Souza Filippo Fernandes, Carine Faria, Laura de Góes Campos, Eduardo Mariani Pires de Campos, Bruna Tolentino Caldeira, Rodrigo de Souza Abreu, João Pedro Afonso Nascimento, Lucas Gonçalves Dias Barreto, Julio Flávio Meirelles Marchini, Vitor Macedo Brito Medeiros, Felippe Lazar Neto, Ligia Trombetta Lima, Geovane Wiebelling da Silva, Luiza Boscolo, Tales Cabral Monsalvarga, Andrew Araujo Tavares, Pedro Antonio Araújo Simões, Mauricio Ursoline do Nascimento, Luz Marina Gomez Gomez, Júlio César Garcia de Alencar, Rodrigo Antonio Brandão Neto, Mariana Mendes Gonçalves Cimatti De Calasans, Ester Minã Gomes da Silva, Renata Kan Nishiaka, Fernanda Máximo Fonseca e Silva, Alicia Dudy Müller Veiga, Gustavo Biz Martins, Felipe Liger Moreira, Gabriel Travessini, Maria Clara Saad Menezes, João Martelleto Baptista, Alexandre Lemos Bortolotto, Marcelo de Oliveira Silva, Felipe Mouzo Bortoleto, Henrique Tibucheski dos Santos, Ademar Lima Simões, Arthur Petrillo Bellintani, Carlos Eduardo Umehara Juck, Stefany Franhan Barbosa de Souza, and Bianca Ruiz Nicolao
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Male ,0301 basic medicine ,Pneumonia severity index ,coronavirus ,Psychological intervention ,severity ,Validation Studies as Topic ,Severity of Illness Index ,law.invention ,0302 clinical medicine ,Community-acquired pneumonia ,Risk Factors ,law ,Hospital Mortality ,030212 general & internal medicine ,validation ,Aged, 80 and over ,Mortality rate ,General Medicine ,Middle Aged ,Prognosis ,Intensive care unit ,Community-Acquired Infections ,Hospitalization ,Intensive Care Units ,Infectious Diseases ,Area Under Curve ,Original Article ,Female ,Brazil ,Adult ,Microbiology (medical) ,medicine.medical_specialty ,030106 microbiology ,Risk Assessment ,03 medical and health sciences ,Internal medicine ,Prohibitins ,medicine ,pneumonia ,Humans ,Aged ,Retrospective Studies ,Receiver operating characteristic ,business.industry ,COVID-19 ,Retrospective cohort study ,prediction ,medicine.disease ,mortality ,Pneumonia ,Spain ,business - 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 Sao 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 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 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.
- Published
- 2021
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