Emergency Department, ASST Papa Giovanni XXIII, Bergamo.
University of Milan; Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo.
Monaldi Arch Chest Dis. 2022 Feb 22;92(4). doi: 10.4081/monaldi.2022.2054.
The aim of our study is to evaluate the accuracy of CURB-65 and Pneumonia Severity Index (PSI), the most widely used scores for community acquired pneumonia, and MuLBSTA, a viral pneumonia score, in predicting 28-day mortality in Coronavirus Disease 2019 (COVID-19) pneumonia.We retrospectively collected clinical data of consecutive patients with laboratory-confirmed COVID-19 pneumonia admitted at Papa Giovanni XXIII Hospital from February 23rd to March 14th, 2020. We calculated at Emergency Department (ED) presentation CURB-65, PSI and MuLBSTA and we compared their performances in discriminating between survivors and non-survivors at 28 days. Among 431 hospitalized patients, the majority presented with hypoxic respiratory failure: median (interquartile range, IQR) PaO2/FiO2 ratio at admission was 228.6 (142.0-278.1). In the first 24 hours, 111 (27%) patients were administered low-flow oxygen cannula, 50 (12%) Venturi Mask, 95 (23%) non-rebreather mask, 106 (26%) non-invasive ventilation, 12 (3%) mechanical ventilation and 41 (9%) were not administered oxygen therapy. Mortality rate at 28-day was 35% (150/431). Between survivors and non-survivors, median (IQR) scores were, respectively, 1.0 (1.0-2.0) and 2.0 (2.0-3.0) for CURB-65 (p<0.001); 90.5 (76.0-105.5) and 115.0 (100.0-129.0) for PSI (p<0.001); 7.0 (5.0-10.0) and 11.0 (9.0-13.0) for MuLBSTA (p<0.001). Areas under the receiver operating characteristic curve (AUCs) for each score were, respectively, 0.725 (0.662-0.787), 0.776 (0.693-0.859) and 0.743 (0.680-0.806) (p>0,05). PSI and MuLBSTA did not show a better performance when compared to CURB-65. Although CURB-65, PSI and MuLBSTA scores are useful tools to discriminate between survivors and non-survivors in COVID-19 pneumonia, their diagnostic accuracy in discriminating 28-day mortality in COVID-19 pneumonia is moderate, as confirmed by AUCs <0.80, and there is a potential underestimation of disease severity in the low-risk classes. For this reason, they should not be recommended in ED to decide between inpatient and outpatient management in patients affected by COVID-19 pneumonia.
我们的研究目的是评估 CURB-65 和肺炎严重指数（PSI）这两种最常用于社区获得性肺炎的评分系统，以及 MuLBSTA 病毒肺炎评分在预测 2019 冠状病毒疾病（COVID-19）肺炎 28 天死亡率方面的准确性。我们回顾性收集了 2020 年 2 月 23 日至 3 月 14 日在 Papa Giovanni XXIII 医院住院的经实验室确诊的 COVID-19 肺炎患者的临床数据。我们在急诊室（ED）就诊时计算了 CURB-65、PSI 和 MuLBSTA，并比较了它们在区分 28 天内幸存者和非幸存者方面的表现。在 431 名住院患者中，大多数患者表现为低氧性呼吸衰竭：入院时中位数（四分位距，IQR）PaO2/FiO2 比值为 228.6（142.0-278.1）。在最初的 24 小时内，111 名（27%）患者给予低流量氧气管，50 名（12%）文丘里面罩，95 名（23%）非再呼吸面罩，106 名（26%）无创通气，12 名（3%）机械通气，41 名（9%）未给予氧疗。28 天死亡率为 35%（150/431）。在幸存者和非幸存者之间，CURB-65 中位数（IQR）评分分别为 1.0（1.0-2.0）和 2.0（2.0-3.0）（p<0.001）；PSI 中位数（IQR）评分分别为 90.5（76.0-105.5）和 115.0（100.0-129.0）（p<0.001）；MuLBSTA 中位数（IQR）评分分别为 7.0（5.0-10.0）和 11.0（9.0-13.0）（p<0.001）。每个评分的受试者工作特征曲线下面积（AUC）分别为 0.725（0.662-0.787）、0.776（0.693-0.859）和 0.743（0.680-0.806）（p>0.05）。PSI 和 MuLBSTA 与 CURB-65 相比并没有表现出更好的性能。尽管 CURB-65、PSI 和 MuLBSTA 评分是区分 COVID-19 肺炎幸存者和非幸存者的有用工具，但它们在区分 COVID-19 肺炎 28 天死亡率方面的诊断准确性中等，AUC 值均<0.80，并且在低危人群中存在疾病严重程度的潜在低估。因此，不建议在 ED 中使用这些评分来决定 COVID-19 肺炎患者的住院或门诊管理。
