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Original article
DOI: 10.1016/j.medcle.2021.01.011
Application of validated severity scores for pneumonia caused by SARS-CoV-2
Aplicación de escalas pronósticas de gravedad en la neumonía por SARS-CoV-2
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Violeta Esteban Rondaa,
Corresponding author
esteban_vio@gva.es

Corresponding author.
, Sandra Ruiz Alcaraza, Paloma Ruiz Torregrosaa, Mario Giménez Suaua, Ester Nofuentes Péreza, José Manuel León Ramíreza,e, Mariano Andrésb,e,f, Óscar Moreno-Pérezc,e,f, Alfredo Candela Blanesa,e, Joan Gil Carbonella,e, Esperanza Merino de Lucasd,e
a Servicio de Neumología, Hospital General Universitario de Alicante, Alicante, Spain
b Servicio de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain
c Servicio de Endocrinología y Nutrición, Hospital General Universitario de Alicante, Alicante, Spain
d Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Alicante, Spain
e Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
f Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche; Hospital General Universitario de Alicante, Elche (Alicante), Spain
Received 08 November 2020. Accepted 19 January 2021
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Tables (3)
Table 1. Prognostic scales analysed in the study with their different variables and score.
Table 2. Precision of the prognostic scales for mortality in SARS-CoV-2 pneumonia (n = 208).
Table 3. Precision of the prognostic scales for endotracheal intubation in SARS-CoV-2 pneumonia (n = 162).
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Abstract
Objectives

Compare the accuracy of PSI, CURB-65, MuLBSTA and COVID-GRAM prognostic scores to predict mortality, the need for invasive mechanical ventilation (IMV) in patients with pneumonia caused by SARS-CoV-2 and assess the coexistence of bacterial respiratory tract infection during admission.

Methods

Retrospective observational study that included hospitalized adults with pneumonia caused by SARS-CoV-2 from 15/03 to 15/05/2020. We excluded immunocompromised patients, nursing home residents and those admitted in the previous 14 days for another reasons. Analysis of ROC curves was performed, calculating the area under the curve for the different scales, as well as sensitivity, specificity and predictive values.

Results

208 patients were enrolled, aged 63 ± 17 years, 577% were men. 38 patients were admitted to ICU (235%), of these patients 33 required IMV (868%), with an overall mortality of 125%. Area under the ROC curves for mortality of the scores were: PSI 082 (95% CI 073–091), CURB-65 082 (073–091), MuLBSTA 072 (062–081) and COVID-GRAM 086 (070–1). Area under the curve for needing IMV was: PSI 073 (95% CI 064–082), CURB-65 066 (055–077), MuLBSTA 078 (069–086) and COVID-GRAM 076 (067–085), respectively. Patients with bacterial co-infections of the respiratory tract were 20 (9,6%), the most frequent strains being Pseudomonas aeruginosa and Klebsiella pneumoniae.

Conclusions

In our study, the COVID-GRAM score was the most accurate to identify patients with higher mortality with pneumonia caused by SARS-CoV-2; however, none of these scores accurately predicts the need for IMV with ICU admission. 10% of patients admitted presented bacterial respiratory co-infection.

Keywords:
Penumonia
COVID-19
Severity scores
Coronavirus
Resumen
Objetivos

Comparar el rendimiento de las escalas pronósticas PSI, CURB-65, MuLBSTA y COVID-GRAM para predecir mortalidad y necesidad de ventilación mecánica invasiva (VMI) en pacientes con neumonía por SARS-CoV-2. Valorar la existencia de coinfección bacteriana respiratoria durante el ingreso.

Método

Estudio observacional retrospectivo que incluyó adultos hospitalizados con neumonía por SARS-CoV-2 del 15/03 al 15/05/2020. Se excluyeron aquellos inmunodeprimidos, institucionalizados e ingresados en los 14 días previos por otro motivo. Se realizó un análisis de curvas ROC, calculando el área bajo la curva para las diferentes escalas, así como sensibilidad, especificidad y valores predictivos.

Resultados

Se incluyeron 208 pacientes, con edad de 63 ± 17 años; el 57,7% eran hombres. Ingresaron en UCI 38 (23,5%), precisando de estos VMI 33 (86,8%), con una mortalidad global del 12,5%. Las áreas bajo las curvas ROC para mortalidad de los scores fueron: PSI 0,82 (95% IC 0,73–0,91), CURB-65 0,82 (0,73–0,91), MuLBSTA 0,72 (0,62–0,81) y COVID-GRAM 0,86 (0,70–1). Las áreas para necesidad de VMI fueron: PSI 0,73 (95% IC 0,64–0,82), CURB-65 0,66 (0,55–0,77), MuLBSTA 0,78 (0,69–0,86) y COVID-GRAM 0,76 (0,67–0,85), respectivamente. Los pacientes que presentaron coinfección bacteriana respiratoria fueron 20 (9.6%) siendo los gérmenes más frecuentes Pseudomonas aeruginosa y Klebsiella pneumoniae.

Conclusiones

En nuestro estudio el score COVID-GRAM fue el más preciso para identificar los pacientes con mayor mortalidad ingresados con neumonía por SARS-CoV-2, no obstante, ninguno de estos scores predice de forma precisa la necesidad de VMI con ingreso en UCI. El 10% de los pacientes presentó coinfección bacteriana respiratoria.

Palabras clave:
Neumonía
COVID-19
Escalas pronósticas
Coronavirus

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