Application of validated severity scores for pneumonia caused by SARS-CoV-2

Abstract

ObjectivesCompare the accuracy of PSI, CURB-65, MuLBSTA and COVID-GRAM prognostic scores to predict mortality, the need for invasive mechanical ventilation (IMV) in patients with pneumonia caused by SARS-CoV-2 and assess the coexistence of bacterial respiratory tract infection during admission. MethodsRetrospective observational study that included hospitalized adults with pneumonia caused by SARS-CoV-2 from 15/03 to 15/05/2020. We excluded immunocompromised patients, nursing home residents and those admitted in the previous 14 days for another reasons. Analysis of ROC curves was performed, calculating the area under the curve for the different scales, as well as sensitivity, specificity and predictive values. Results208 patients were enrolled, aged 63 ± 17 years, 577% were men. 38 patients were admitted to ICU (235%), of these patients 33 required IMV (868%), with an overall mortality of 125%. Area under the ROC curves for mortality of the scores were: PSI 082 (95% CI 073–091), CURB-65 082 (073–091), MuLBSTA 072 (062–081) and COVID-GRAM 086 (070–1). Area under the curve for needing IMV was: PSI 073 (95% CI 064–082), CURB-65 066 (055–077), MuLBSTA 078 (069–086) and COVID-GRAM 076 (067–085), respectively. Patients with bacterial co-infections of the respiratory tract were 20 (9,6%), the most frequent strains being Pseudomonas aeruginosa and Klebsiella pneumoniae. ConclusionsIn our study, the COVID-GRAM score was the most accurate to identify patients with higher mortality with pneumonia caused by SARS-CoV-2; however, none of these scores accurately predicts the need for IMV with ICU admission. 10% of patients admitted presented bacterial respiratory co-infection.