Validation of the qSOFA and CRB-65 in SARS-CoV-2-infected community-acquired pneumonia

Abstract

RationalePrognostic accuracy of the qSOFA and CRB-65 risk scores has not been widely evaluated in SARS-CoV-2 infected compared to SARS-CoV-2 non-infected community-acquired pneumonia (CAP).ObjectivesThe aim was to validate the qSOFA(−65) and CRB-65 scores in a large cohort of SARS-CoV-2 infected and non-infected CAP patients.MethodsWe included all cases with CAP hospitalized in 2020 from the German nationwide mandatory quality assurance program and compared SARS-CoV-2 infected with non-infected cases. We excluded cases with unclear SARS-CoV-2 infection state, transferred to another hospital or on mechanical ventilation (MV) during admission. Predefined outcomes were hospital mortality and need of MV.ResultsAmong 68 594 SARS-CoV-2 infected patients, hospital mortality (22.7%) and MV (14.9%) was significantly higher when compared to 167.880 SARS-CoV-2 negative patients (15.7% and 9.2%, respectively). All CRB-65 and qSOFA criteria were associated with both outcomes, and age dominated mortality prediction in SARS-CoV-2 (relative risk >9). Scores including the age-criterion had higher AUCs for mortality in SARS-CoV-2 positive (e.g.CRB-65 AUC 0.76) compared to SARS-CoV-2 negative (AUC 0.68) patients, and NPV was highest for qSOFA-65=0 (98.2%). Sensitivity for MV prediction was poor with all scores (AUCs 0.59–0.62), and NPVs were insufficient (qSOFA-65=0 missed 1490/10 198∼ 15% patients with MV). Results were similar when excluding frail and palliative patients.ConclusionsHospital mortality and MV rates were higher in SARS-CoV-2 positive compared to SARS-CoV-2 negative CAP. For SARS-CoV-2 positive CAP, the CRB-65 and qSOFA-65 scores showed adequate prediction of mortality, but not of MV.