Common scoring systems comparably predict mortality in SARS-CoV-2-related CAP
Two widely used clinical scoring systems — the Pneumonia Severity Index and CURB-65 score — comparatively predicted in-hospital mortality in patients with and without SARS-CoV-2-related community-acquired pneumonia, researchers reported.
“Triaging patients with SARS-CoV-2 community-acquired pneumonia requires an accurate assessment of mortality risk; however, this is challenging given the novelty of the virus,” James Bradley, MD, resident physician in the division of pulmonary, critical care medicine and sleep disorders at the University of Louisville in Kentucky, and colleagues wrote in Chest.
Researchers conducted a secondary analysis of two perspective cohorts of patients with SARS-CoV-2-related community-acquired pneumonia (CAP) or CAP unrelated to SARS-CoV-2 from eight hospitals in Louisville. The researchers collected data on demographics, comorbidities and physical examination findings to calculate the Pneumonia Severity Index (PSI) and CURB-65 (confusion, urea, respiratory rate, blood pressure and age at least 65 years) score.
The primary outcome was the ability of the PSI and CURB-65 score to predict in-hospital mortality among patients with and without COVID-19 CAP.
Overall, 121 patients (mean age, 72 years; 57% men) died or were on hospice care and 511 patients (mean age, 60 years; 44% men) were discharged alive.
The in-hospital mortality rate was 19% for patients with SARS-CoV-2-related CAP and 6.5% for those with non-SARS-CoV-2-related CAP.
Receiver operating characteristic curve analysis for the PSI score yielded an area under the curve of 0.82 for patients with SARS-CoV-2-related CAP and an AUC of 0.79 for patients with non-SARS-CoV-2-related CAP. For the CURB-65 score, receiver operating characteristic curve analysis yielded an AUC of 0.79 and 0.75, respectively.
Researchers reported the addition of D-dimer (optimal cutoff, 1,813 µg/mL) and procalcitonin (optimal cutoff, 0.19 ng/mL) to the PSI and CURB-65 score resulted in a negligible improvement in prognostic performance for patients with SARS-CoV-2-related CAP.
“The addition of these laboratory values for the initial prognostic assessment of patients who have received a diagnosis of SARS-CoV-2 CAP is not warranted,” the researchers wrote. “Our study results suggest that in patients with CAP, regardless of cause, PSI and CURB-65 score remain adequate for predicting mortality in clinical practice.”