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Published on: December 19, 2020
Pneumonia severity indices predict prognosis in coronavirus disease-2019
E S Ucan1, A Ozgen Alpaydin1, S S Ozuygur1
1Department of Pulmonary Diseases, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
Insights
Community-acquired pneumonia (CAP) severity scores effectively predict COVID-19 outcomes, with some nonspecific scores outperforming COVID-19 specific indices. The CALL score is useful for outpatient management decisions in COVID-19 patients.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Early recognition of severe coronavirus disease-19 (COVID-19) is crucial for optimal patient care and resource allocation.
- Assessing illness severity aids in timely clinical decisions and management strategies.
Purpose of the Study:
- To evaluate the predictive performance of established community-acquired pneumonia (CAP) severity scores and novel COVID-19 specific indices.
- To compare the accuracy of these scores in predicting severe COVID-19 and mortality.
Main Methods:
- Retrospective cohort study of hospitalized COVID-19 patients.
- Calculation and analysis of CURB-65, PSI, A-DROP, CALL, and COVID-GRAM scores.
- Evaluation of prediction accuracy using receiver-operating-characteristic (ROC) analysis and Cox regression.
Main Results:
- Nonspecific CAP scores demonstrated strong predictive capabilities for COVID-19 mortality (AUCs ranging from 0.828 to 0.875).
- A-DROP and CURB-65 scores showed the strongest association with mortality.
- The CALL score identified a low-risk group with zero out-of-hospital mortality.
Conclusions:
- Traditional CAP severity scores are valuable for predicting COVID-19 severity and mortality.
- Surprisingly, nonspecific scoring systems outperformed COVID-19 specific indices in this cohort.
- The CALL score shows promise for guiding outpatient management decisions in COVID-19.
Background:
Early recognition of the severe illness is critical in coronavirus disease-19 (COVID-19) to provide best care and optimize the use of limited resources.
Objectives:
We aimed to determine the predictive properties of common community-acquired pneumonia (CAP) severity scores and COVID-19 specific indices.
Methods:
In this retrospective cohort, COVID-19 patients hospitalized in a teaching hospital between 18 March-20 May 2020 were included. Demographic, clinical, and laboratory characteristics related to severity and mortality were measured and CURB-65, PSI, A-DROP, CALL, and COVID-GRAM scores were calculated as defined previously in the literature. Progression to severe disease and in-hospital/overall mortality during the follow-up of the patients were determined from electronic records. Kaplan-Meier, log-rank test, and Cox proportional hazard regression model was used. The discrimination capability of pneumonia severity indices was evaluated by receiver-operating-characteristic (ROC) analysis.
Results:
Two hundred ninety-eight patients were included in the study. Sixty-two patients (20.8%) presented with severe COVID-19 while thirty-one (10.4%) developed severe COVID-19 at any time from the admission. In-hospital mortality was 39 (13.1%) while the overall mortality was 44 (14.8%). The mortality in low-risk groups that were identified to manage outside the hospital was 0 in CALL Class A, 1.67% in PSI low risk, and 2.68% in CURB-65 low-risk. However, the AUCs for the mortality prediction in COVID-19 were 0.875, 0.873, 0.859, 0.855, and 0.828 for A-DROP, PSI, CURB-65, COVID-GRAM, and CALL scores respectively. The AUCs for the prediction of progression to severe disease was 0.739, 0.711, 0,697, 0.673, and 0.668 for CURB-65, CALL, PSI, COVID-GRAM, A-DROP respectively. The hazard ratios (HR) for the tested pneumonia severity indices demonstrated that A-DROP and CURB-65 scores had the strongest association with mortality, and PSI, and COVID-GRAM scores predicted mortality independent from age and comorbidity.
Conclusion:
Community-acquired pneumonia (CAP) scores can predict in COVID-19. The indices proposed specifically to COVID-19 work less than nonspecific scoring systems surprisingly. The CALL score may be used to decide outpatient management in COVID-19.
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