Richter Tina, Tesch Falko, Schmitt Jochen, Koschel Dirk, Kolditz Martin
Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Dresden University Centre for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
ERJ Open Res. 2023 Jun 19;9(3). doi: 10.1183/23120541.00168-2023. eCollection 2023 May.
Prognostic accuracy of the quick sequential organ failure assessment (qSOFA) and CRB-65 (confusion, respiratory rate, blood pressure and age (≥65 years)) risk scores have not been widely evaluated in patients with SARS-CoV-2-positive compared to SARS-CoV-2-negative community-acquired pneumonia (CAP). The aim of the present study was to validate the qSOFA(-65) and CRB-65 scores in a large cohort of SARS-CoV-2-positive and SARS-CoV-2-negative CAP patients.
We included all cases with CAP hospitalised in 2020 from the German nationwide mandatory quality assurance programme and compared cases with SARS-CoV-2 infection to cases without. We excluded cases with unclear SARS-CoV-2 infection state, transferred to another hospital or on mechanical ventilation during admission. Predefined outcomes were hospital mortality and need for mechanical ventilation.
Among 68 594 SARS-CoV-2-positive patients, hospital mortality (22.7%) and mechanical ventilation (14.9%) were significantly higher when compared to 167 880 SARS-CoV-2-negative patients (15.7% and 9.2%, respectively). All CRB-65 and qSOFA criteria were associated with both outcomes, and age dominated mortality prediction in SARS-CoV-2 (risk ratio >9). Scores including the age criterion had higher area under the curve (AUCs) for mortality in SARS-CoV-2-positive patients ( CRB-65 AUC 0.76) compared to SARS-CoV-2 negative patients (AUC 0.68), and negative predictive value was highest for qSOFA-65=0 (98.2%). Sensitivity for mechanical ventilation prediction was poor with all scores (AUCs 0.59-0.62), and negative predictive values were insufficient (qSOFA-65=0 missed 1490 out of 10 198 patients (∼15%) with mechanical ventilation). Results were similar when excluding frail and palliative patients.
Hospital mortality and mechanical ventilation rates were higher in SARS-CoV-2-positive than SARS-CoV-2-negative CAP. For SARS-CoV-2-positive CAP, the CRB-65 and qSOFA-65 scores showed adequate prediction of mortality but not of mechanical ventilation.
与新冠病毒阴性的社区获得性肺炎（CAP）患者相比，快速序贯器官衰竭评估（qSOFA）和CRB-65（意识障碍、呼吸频率、血压和年龄（≥65岁））风险评分在新冠病毒阳性患者中的预后准确性尚未得到广泛评估。本研究的目的是在一大群新冠病毒阳性和阴性的CAP患者中验证qSOFA(-65)和CRB-65评分。
我们纳入了2020年德国全国强制性质量保证计划中所有因CAP住院的病例，并将新冠病毒感染病例与未感染病例进行比较。我们排除了新冠病毒感染状态不明、转至其他医院或入院时接受机械通气的病例。预定义的结局是医院死亡率和机械通气需求。
在68594例新冠病毒阳性患者中，医院死亡率（22.7%）和机械通气率（14.9%）显著高于167880例新冠病毒阴性患者（分别为15.7%和9.2%）。所有CRB-65和qSOFA标准均与这两个结局相关，且年龄在新冠病毒感染患者的死亡率预测中占主导地位（风险比>9）。与新冠病毒阴性患者（AUC 0.68）相比，包含年龄标准的评分在新冠病毒阳性患者的死亡率预测中具有更高的曲线下面积（AUCs）（CRB-65 AUC 0.76），且qSOFA-65=0时的阴性预测值最高（98.2%）。所有评分对机械通气预测的敏感性均较差（AUCs 0.59-0.62），且阴性预测值不足（qSOFA-65=0在10198例接受机械通气的患者中漏诊了1490例（约15%））。排除体弱和姑息治疗患者后结果相似。
新冠病毒阳性的CAP患者的医院死亡率和机械通气率高于新冠病毒阴性患者。对于新冠病毒阳性的CAP，CRB-65和qSOFA-65评分对死亡率有充分的预测价值，但对机械通气则不然。
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