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

Neto, Felippe Lazar; Marino, Lucas Oliveira; Torres, Antoni; Cillóniz, Catia; Marchini, Júlio Flávio Meirelles; Alencar, Júlio César Garcia de; Palomeque, Andrea; Albacar, Núria; Neto, Rodrigo Antônio Brandão; Souza, Heraldo Possolo de; Ranzani, Otávio T.; Bortolotto, Alexandre L.; Veiga, Alicia Dudy Müller; Bellintani, Arthur Petrillo; Fantinatti, Beatriz Larios; Nicolao, Bianca Ruiz; Caldeira, Bruna Tolentino; Juck, Carlos Eduardo Umehara; Bueno, Cauê Gasparatto; Takamune, Diego Juniti; Guidotte, Diogo Visconti; D’Souza, Edwin Albert; Silva, Emily Cristine Oliveira; Miyaguchi, Erika Thiemy Brito; Silva, Ester Minã Gomes da; Moreira, Everton Luis Santos; Silva, Fernanda Máximo Fonseca e; Escudeiro, Gabriel de Paula Maroni; Travessini, Gabriel; Costa, Giovanna Babikian; Santos, Henrique; Omori, Isabela Harumi; Baptista, Jorge; Nascimento, João Pedro Afonso; Campos, Laura de Góes; Lima, Ligia Trombetta; Boscolo, Luiza; Pandolfi, M.; Silva, Marcelo de Oliveira; Sanches, Marcelo Petrof; Menezes, Maria Clara Saad; Calasans, Mariana Mendes Gonçalves Cimatti De; Faria, Matheus Finardi Lima de; Martins, Nilo Arthur Bezerra; Moura, Patricia Albuquerque de; Simões, Pedro Antonio Araújo; Luna, Rafael Berenguer; Nishiaka, Renata Kan; Miléo, Rodrigo Cezar; Abreu, Rodrigo de; Toccoli, Rodrigo Werner; Monsalvarga, Tales Cabral; Medeiros, Vitor Macedo Brito; Fernandes, Yasmine Souza Filippo; Simões, Ademar Lima; Tavares, Andrew Araujo; Pereira, Clara Carvalho de Alves; Ribeiro, Daniel Rodrigues; Francesco, Danilo Dias de; Emerenciano, Débora Lopes; Campos, Eduardo Mariani Pires de; Moreira, Felipe Liger; Bortoleto, Felipe Mouzo; Martínez, Gabriel; Silva, Geovane Wiebelling da; Martins, Gustavo Biz; Fortes, Julio C. L.; Barreto, Lucas Gonçalves Dias; Rosa, Maria Lorraine Silva de; Nascimento, Mauricio Ursoline do; Pisciolaro, Rafael Faria; Xavier, Rodolfo Affonso; Souza, Stefany Franhan Barbosa de; Netto, Thiago Areas Lisboa; Ribeiro, Sabrina Corrêa da Costa; Faria, Carine C.; Rahhal, Hassam; Padrão, Eduardo Messias Hirano; Valente, Fernando Salvetti; Chio, Yago Henrique Padovan; Gómez, Luz Marina Gómez

doi:10.1016/j.cmi.2021.03.002

Cited by 32 publications

(25 citation statements)

References 31 publications

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“…5 Furthermore, independent external validation has demonstrated consistent performance worldwide. 6–10 …”

Section: Introductionmentioning

confidence: 99%

Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol

Knight

et al. 2021

Thorax

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Purpose To prospectively validate two risk scores to predict mortality (4C Mortality) and in-hospital deterioration (4C Deterioration) among adults hospitalised with COVID-19. Methods Prospective observational cohort study of adults (age ≥18 years) with confirmed or highly suspected COVID-19 recruited into the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) study in 306 hospitals across England, Scotland and Wales. Patients were recruited between 27 August 2020 and 17 February 2021, with at least 4 weeks follow-up before final data extraction. The main outcome measures were discrimination and calibration of models for in-hospital deterioration (defined as any requirement of ventilatory support or critical care, or death) and mortality, incorporating predefined subgroups. Results 76 588 participants were included, of whom 27 352 (37.4%) deteriorated and 12 581 (17.4%) died. Both the 4C Mortality (0.78 (0.77 to 0.78)) and 4C Deterioration scores (pooled C-statistic 0.76 (95% CI 0.75 to 0.77)) demonstrated consistent discrimination across all nine National Health Service regions, with similar performance metrics to the original validation cohorts. Calibration remained stable (4C Mortality: pooled slope 1.09, pooled calibration-in-the-large 0.12; 4C Deterioration: 1.00, –0.04), with no need for temporal recalibration during the second UK pandemic wave of hospital admissions. Conclusion Both 4C risk stratification models demonstrate consistent performance to predict clinical deterioration and mortality in a large prospective second wave validation cohort of UK patients. Despite recent advances in the treatment and management of adults hospitalised with COVID-19, both scores can continue to inform clinical decision making. Trial registration number NCT66726260.

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“…5 Furthermore, independent external validation has demonstrated consistent performance worldwide. 6–10 …”

Section: Introductionmentioning

confidence: 99%

Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol

Knight

et al. 2021

Thorax

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“…These variables make up the 4C score [18]. We had demonstrated that 4C score was an accurate predictor of outcomes in our population [19]. In this present study, we did not have access to the Glasgow coma scale, and we did not use this variable for adjusted analyzes.…”

Section: Discussionmentioning

confidence: 81%

Timing to Intubation COVID-19 Patients: Can We Put It Off Until Tomorrow?

Alencar

Sternlicht

Veiga

et al. 2021

Preprint

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Background: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the relationship between intubation day and mortality in COVID-19 patients. Methods: We performed a unicentric retrospective cohort study considering all adult laboratory-confirmed SARS-CoV-2 infection consecutively admitted at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, between March 2020 and August 2020 requiring invasive mechanical ventilation. The primary outcome was all-cause mortality within 28 days after intubation, and a Cox model was used to evaluate the effect of time from onset of symptoms to intubation in mortalityResults: A total of 592 (20%) adult consecutive patients out of 3020 admitted with COVID-19 were intubated during the study period. The median time from admission to intubation was one day (interquartile range, 0-3), and 310 patients (52%) who were intubated and mechanically ventilated deceased 28 days after intubation. Each additional day between the onset of symptoms and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.018; 95% CI, 1.005-1.03).Conclusion: Among patients infected with SARS-CoV-2 who were intubated and mechanically ventilated, delaying intubation in the course of symptoms may be associated with higher mortality.Trial registration: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068.

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“…External validation was essential in other cohorts as well as this one since it was expected that newer scoring systems outperform older ones ( Neto et al, 2021 ). PSI and CURB-65 have been used for risk stratification and prognostic assessment in patients with COVID-19 previously ( Wang et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

External Validation and Recalibration of the CURB-65 and PSI for Predicting 30-Day Mortality and Critical Care Intervention in Multiethnic Patients with COVID-19

Elmoheen¹,

Abdelhafez²,

Salem³

et al. 2021

International Journal of Infectious Diseases

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Objectives To validate and recalibrate the CURB-65 and pneumonia severity index (PSI) in predicting 30-day mortality and critical care intervention (CCI) in a multiethnic population with COVID-19, along with evaluating both models in predicting CCI. Methods Retrospective data was collected for 1181 patients admitted to the largest hospital in Qatar with COVID-19 pneumonia. The area under the curve (AUC), calibration curves, and other metrics were bootstrapped to examine the performance of the models. Variables constituting the CURB-65 and PSI scores underwent further analysis using the Least Absolute Shrinkage and Selection Operator (LASSO) along with logistic regression to develop a model predicting CCI. Complex machine learning models were built for comparative analysis. Results The PSI performed better than CURB-65 in predicting 30-day mortality (AUC 0.83, 0.78 respectively), while CURB-65 outperformed PSI in predicting CCI (AUC 0.78, 0.70 respectively). The modified PSI/CURB-65 model (respiratory rate, oxygen saturation, hematocrit, age, sodium, and glucose) predicting CCI had excellent accuracy (AUC 0.823) and good calibration. Conclusions Our study recalibrated, externally validated the PSI and CURB-65 for predicting 30-day mortality and CCI, and developed a model for predicting CCI. Our tool can potentially guide clinicians in Qatar to stratify patients with COVID-19 pneumonia.

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

Cited by 32 publications

References 31 publications

Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol

Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol

Timing to Intubation COVID-19 Patients: Can We Put It Off Until Tomorrow?

External Validation and Recalibration of the CURB-65 and PSI for Predicting 30-Day Mortality and Critical Care Intervention in Multiethnic Patients with COVID-19

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