First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
Department of Emergency Medicine, Kansai Medical University Medical Center, 10-15 Bunen-cho, Moriguchi, Osaka, 570-8507, Japan.
Respir Investig. 2024 Mar;62(2):187-191. doi: 10.1016/j.resinv.2023.12.017. Epub 2024 Jan 6.
SARS-CoV-2 causes frequent outbreaks in elderly care facilities that meet the criteria for nursing and healthcare-associated pneumonia (NHCAP). We evaluated whether the Japanese Respiratory Society (JRS) atypical pneumonia prediction score could be adapted to the diagnosis of nursing and healthcare acquired COVID-19 (NHA-COVID-19) with pneumonia.
We analyzed 516 pneumonia patients with NHA-COVID-19 and compared them with 1505 pneumonia patients with community-associated COVID-19 (CA-COVID-19). NHA-COVID-19 patients were divided into six groups; 80 cases had the ancestral strain, 76 cases had the Alfa variant, 30 cases had the Delta variant, 120 cases had the Omicron subvariant BA.1, 53 cases had the Omicron subvariant BA.2, and 157 cases had the Omicron subvariant BA.5.
The sensitivities of the diagnosis of atypical pneumonia in patients with NHA-COVID-19 based on four or more predictors were 22.8 % in the ancestral strain group, 32.0 % in the Alfa variant group, 34.5 % in the Delta variant group, 23.1 % in the BA.1 subvariant group, 32.7 % in the BA.2 subvariant group, and 30.4 % in the BA.5 subvariant group. The diagnostic sensitivity for the presumptive diagnosis of atypical pneumonia was significantly lower for NHA-COVID-19 than for CA-COVID-19 (28.2 % vs 64.1 %, p < 0.0001).
Our present study demonstrated that the JRS atypical pneumonia prediction score is not a useful tool in elderly patients even if there is a lot of atypical pneumonia in the NHCAP group. The caution is necessary that JRS atypical pneumonia prediction score was not fully applied to prediction for NHA-COVID-19 pneumonia.
SARS-CoV-2 经常在符合护理和医疗保健相关性肺炎（NHCAP）标准的养老院爆发。我们评估了日本呼吸学会（JRS）非典型性肺炎预测评分是否可以适用于诊断具有肺炎的护理和医疗保健获得性 COVID-19（NHA-COVID-19）。
我们分析了 516 例患有 NHA-COVID-19 的肺炎患者，并将其与 1505 例患有社区获得性 COVID-19（CA-COVID-19）的肺炎患者进行了比较。NHA-COVID-19 患者分为六组；80 例为原始株，76 例为 Alfa 变异株，30 例为 Delta 变异株，120 例为 Omicron 亚变体 BA.1，53 例为 Omicron 亚变体 BA.2，157 例为 Omicron 亚变体 BA.5。
基于四个或更多预测因素，NHA-COVID-19 患者非典型性肺炎诊断的灵敏度在原始株组为 22.8%，Alfa 变异株组为 32.0%，Delta 变异株组为 34.5%，BA.1 亚变体组为 23.1%，BA.2 亚变体组为 32.7%，BA.5 亚变体组为 30.4%。与 CA-COVID-19 相比，NHA-COVID-19 对非典型性肺炎的假定诊断的诊断敏感性显著降低（28.2%比 64.1%，p<0.0001）。
我们的研究表明，即使在 NHCAP 组中存在大量非典型性肺炎，JRS 非典型性肺炎预测评分也不是老年患者的有用工具。需要注意的是，JRS 非典型性肺炎预测评分不能完全应用于预测 NHA-COVID-19 肺炎。
