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Assessment of risk scores in Covid-19
Marta María García Clemente1, Julia Herrero Huertas1, Alejandro Fernández Fernández1
1Pneumologist, HUCA, Oviedo, Spain.
Insights
Commonly used pneumonia risk scores, Pneumonia Severity Index (PSI) and CURB-65, accurately predict mortality in COVID-19 patients. However, these scores are less effective for predicting ICU admission, necessitating new scoring systems for appropriate care decisions.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Respiratory Medicine
Background:
- COVID-19 pneumonia presents a significant challenge in determining patient prognosis and resource allocation.
- Established community-acquired pneumonia (CAP) risk scores, such as PSI and CURB-65, are widely used but their accuracy in COVID-19 requires evaluation.
Purpose of the Study:
- To assess the predictive accuracy of commonly employed risk scores (PSI and CURB-65) for mortality and intensive care unit (ICU) admission in patients with COVID-19 pneumonia.
- To compare the performance of PSI and CURB-65 against other severity scores (SMART-COP, MuLBSTA) in the context of COVID-19.
Main Methods:
- A prospective study involving 249 patients diagnosed with COVID-19 pneumonia.
- Assessment of PSI, CURB-65, SMART-COP, and MuLBSTA scores upon admission.
- Correlation of risk scores with patient outcomes, including mortality and ICU admission, during follow-up until discharge or death.
Main Results:
- Multivariate analysis identified advanced age (>80 years), low lymphocyte count (<800), confusion, and elevated NT-proBNP (>500 pg/mL) as significant predictors of mortality.
- PSI (AUC 0.874) and CURB-65 (AUC 0.852) demonstrated strong predictive accuracy for mortality in COVID-19 patients.
- SMART-COP (AUC 0.749) and MuLBSTA (AUC 0.777) showed better performance for predicting ICU admission compared to PSI (AUC 0.620) and CURB-65 (AUC 0.604).
Conclusions:
- While PSI and CURB-65 are effective for predicting mortality in COVID-19 CAP, they are less reliable for determining the need for hospitalization or ICU admission.
- The findings highlight the need for specialized risk assessment tools to guide clinical decisions regarding the appropriate level of care for COVID-19 pneumonia patients.
- Further research into novel scoring systems tailored for COVID-19 is warranted to improve patient management and resource allocation.
Objective:
To analyse the accuracy of commonly used risk scores (PSI and CURB-65) in predicting mortality and need for ICU admission in Covid-19.
Material And Methods:
Prospective study of patients diagnosed with Covid-19 pneumonia. Patients were followed until home discharge or death. PSI, CURB-65, SMART-COP and MuLBSTA severity scores were assessed on admission. Risk scores were related to mortality and ICU admission.
Results:
About 249 patients, 143 males (57.4%) were included. The mean age was 65.6 + 16.1 years. Factors associates with mortality in the multivariate analysis were age > 80 years (OR: 13.9; 95% CI 3.8-51.1) (P = .000), lymphocytes < 800 (OR: 2.9; CI 95% 1.1-7-9) (P = .040), confusion (OR: 6.3; 95% CI 1.6-24.7) (P = .008) and NT-proBNP > 500 pg/mL (OR: 10.1; 95% CI 1.1-63.1) (P = .039). In predicting mortality, the PSI score: AUC 0.874 (95% CI 0.808-0.939) and the CURB-65 score: AUC 0.852 (95% CI 0.794-0.909) were the ones that obtained the best results. In the need for ICU admission, the SMART-COP score: AUC 0.749 (95% CI 0.695-0.820) and the MuLBSTA score: AUC 0.777 (95% CI 0.713-0.840) were the ones that obtained better results, with significant differences with PSI and CURB-65. The scores with the lowest value for ICU admission prediction were PSI with AUC of 0.620 (95% CI 0.549-0.690) and CURB-65 with AUC of 0.604 (95% CI 0.528-0.680).
Conclusions:
Prognosis scores routinely used for CAP (PSI and CURB-65) were good predictors for mortality in patients with Covid-19 CAP but not for need of hospitalisation or ICU admission. In the evaluation of Covid-19 pneumonia, we need scores that allow to decide the appropriate level of care.
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