First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan.
Department of Emergency Medicine, Kansai Medical University Medical Center, Japan.
J Infect Chemother. 2022 Oct;28(10):1375-1379. doi: 10.1016/j.jiac.2022.06.007. Epub 2022 Jun 16.
The Japanese Respiratory Society (JRS) scoring system is a useful tool for the rapid presumptive diagnosis of atypical pneumonia in non-elderly (aged <60 years) patients. As SARS-CoV-2 vaccination progresses, COVID-19 in elderly people has markedly reduced. We investigated changes in diagnostic usefulness of the JRS scoring system in COVID-19 pneumonia between the Delta variant group (vaccination period) and non-Delta variant group (before the vaccination period).
This study was conducted at five institutions and assessed a total of 1121 patients with COVID-19 pneumonia (298 had the Delta variant). During the vaccination period, the Delta variant has spread and replaced the Alfa variant. We evaluated the vaccination period as the Delta variant group.
Among the six parameters of the JRS scoring system, matching rates of two parameters were higher in the Delta variant group than the non-Delta variant group (pre-vaccination period): age <60 years (77.5% vs 42.2%, P < 0.0001) and no or minor comorbid illness (69.1% vs 57.8%, p = 0.0007). The sensitivity of the diagnosis of atypical pneumonia in patients with COVID-19 pneumonia was significantly higher in the Delta variant group compared with the non-Delta variant group (80.2% vs 58.3%, p < 0.0001). When the diagnostic sensitivity was analyzed for different ages, the diagnostic sensitivities for the Delta variant and non-Delta variant groups were 92.6% and 95.5% for non-elderly patients and 39.1% and 32.5% for elderly patients, respectively.
Our results demonstrated that the JRS scoring system is a useful tool for distinguishing between COVID-19 pneumonia and bacterial pneumonia in the COVID-19 vaccination period, but not before the vaccination period.
日本呼吸学会（JRS）评分系统是一种快速推测非老年（<60 岁）患者非典型肺炎的有用工具。随着 SARS-CoV-2 疫苗接种的推进，老年人的 COVID-19 明显减少。我们调查了 JRS 评分系统在 COVID-19 肺炎中在 Delta 变异株组（接种期）和非 Delta 变异株组（接种前）之间对诊断有用性的变化。
这项研究在五家机构进行，共评估了 1121 例 COVID-19 肺炎患者（298 例为 Delta 变异株）。在接种期间，Delta 变异株已传播并取代了 Alfa 变异株。我们将接种期评估为 Delta 变异株组。
在 JRS 评分系统的六个参数中，Delta 变异株组的两个参数的匹配率高于非 Delta 变异株组（接种前）：年龄<60 岁（77.5%比 42.2%，P<0.0001）和无或轻度合并症（69.1%比 57.8%，p=0.0007）。COVID-19 肺炎患者中不典型肺炎的诊断敏感性在 Delta 变异株组明显高于非 Delta 变异株组（80.2%比 58.3%，P<0.0001）。当分析不同年龄的诊断敏感性时，Delta 变异株组和非 Delta 变异株组的非老年患者的诊断敏感性分别为 92.6%和 95.5%，老年患者分别为 39.1%和 32.5%。
我们的结果表明，JRS 评分系统是区分 COVID-19 肺炎和 COVID-19 疫苗接种期细菌性肺炎的有用工具，但在接种前无效。
