Community-acquired pneumonia severity assessment tools in patients hospitalized with COVID-19: a validation and clinical applicability study
Authors: Felippe Lazar Neto, Lucas Oliveira Marino, Antoni Torres, Catia Cilloniz, Julio Flavio Meirelles Marchini, Julio Cesar Garcia de Alencar, Andrea Palomeque, Núria Albacar, Rodrigo Antônio Brandão Neto, Heraldo Possolo Souza, Otavio T. Ranzani, Alexandre Lemos Bortolotto, Alicia Dudy Müller Veiga, Arthur Petrillo Bellintani, Beatriz Larios Fantinatti, Bianca Ruiz Nicolao, Bruna Tolentino Caldeira, Carlos Eduardo Umehara Juck, Cauê Gasparatto Bueno, Diego Juniti Takamune, Diogo Visconti Guidotte, Edwin Albert D'Souza, Emily Cristine Oliveira Silva, Erika Thiemy Brito Miyaguchi, Ester Minã Gomes da Silva, Everton Luis Santos Moreira, Fernanda Máximo Fonseca e Silva, Gabriel de Paula Maroni Escudeiro, Gabriel Travessini, Giovanna Babikian Costa, Henrique Tibucheski dos Santos, Isabela Harumi Omori, João Martelleto Baptista, João Pedro Afonso Nascimento, Laura de Góes Campos, Ligia Trombetta Lima, Luiza Boscolo, Manuela Cristina Adsuara Pandolfi, Marcelo de Oliveira Silva, Marcelo Petrof Sanches, Maria Clara Saad Menezes, Mariana Mendes Gonçalves Cimatti De Calasans, Matheus Finardi Lima de Faria, Nilo Arthur Bezerra Martins, Patricia Albuquerque de Moura, Pedro Antonio Araújo Simões, Rafael Berenguer Luna, Renata Kan Nishiaka, Rodrigo Cezar Miléo, Rodrigo de Souza Abreu, Rodrigo Werner Toccoli, Tales Cabral Monsalvarga, Vitor Macedo Brito Medeiros, Yasmine Souza Filippo Fernandes, Ademar Lima Simões, Andrew Araujo Tavares, Clara Carvalho de Alves Pereira, Daniel Rodrigues Ribeiro, Danilo Dias de Francesco, Debora Lopes Emerenciano, Eduardo Mariani Pires de Campos, Felipe Liger Moreira, Felipe Mouzo Bortoleto, Gabriel Martinez, Geovane Wiebelling da Silva, Gustavo Biz Martins, Julio Cesar Leite Fortes, Lucas Gonçalves Dias Barreto, Maria Lorraine Silva de Rosa, Mauricio Ursoline do Nascimento, Rafael Faria Pisciolaro, Rodolfo Affonso Xavier, Stefany Franhan Barbosa de Souza, Thiago Areas Lisboa Netto, Sabrina Ribeiro, Carine Faria, Hassam Rahhal, Eduardo Padrão, Fernando Valente, Yago Henrique Padovan Chio, Luz Marina Gomez Gomez
Journal: Clinical Microbiology and Infection (2021)

ObjectiveTo externally validate community-acquired pneumonia (CAP) tools on patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia from two distinct countries, and compare their performance with recently developed COVID-19 mortality risk stratification tools.MethodsWe evaluated 11 risk stratification scores in a binational retrospective cohort of patients hospitalized with COVID-19 pneumonia in São Paulo and Barcelona: Pneumonia Severity Index (PSI), CURB, CURB-65, qSOFA, Infectious Disease Society of America and American Thoracic Society Minor Criteria, REA-ICU, SCAP, SMART-COP, CALL, COVID GRAM and 4C. The primary and secondary outcomes were 30-day in-hospital mortality and 7-day intensive care unit (ICU) admission, respectively. We compared their predictive performance using the area under the receiver operating characteristics curve (AUC), sensitivity, specificity, likelihood ratios, calibration plots and decision curve analysis.ResultsOf 1363 patients, the mean (SD) age was 61 (16) years. The 30-day in-hospital mortality rate was 24.6% (228/925) in São Paulo and 21.0% (92/438) in Barcelona. For in-hospital mortality, we found higher AUCs for PSI (0.79, 95% CI 0.77–0.82), 4C (0.78, 95% CI 0.75–0.81), COVID GRAM (0.77, 95% CI 0.75–0.80) and CURB-65 (0.74, 95% CI 0.72–0.77). Results were similar for both countries. For the 1%–20% threshold range in decision curve analysis, PSI would avoid a higher number of unnecessary interventions, followed by the 4C score. All scores had poor performance (AUC <0.65) for 7-day ICU admission.ConclusionsRecent clinical COVID-19 assessment scores had comparable performance to standard pneumonia prognostic tools. Because it is expected that new scores outperform older ones during development, external validation studies are needed before recommending their use.