Evaluation of Mortality Risk with CURB-65 and PSI in Patients with and Without Geriatric COVID-19 Pneumonia

Murat Duyan; Resmiye Nur Okudan

Araştırma Makalesi

Geriatrik COVID-19 Pnömonisi Olan ve Olmayan Hastalarda CURB-65 ve PSI ile Mortalite Riskinin Değerlendirilmesi

Yıl 2022, Cilt: 5 Sayı: 1, 8 - 22, 30.04.2022

Murat Duyan Resmiye Nur Okudan

Öz

Amaç: 2019 koronavirüs hastalığı (COVID-19) enfeksiyonlarından kaynaklanan pnömoninin değerlendirilmesi, yönetimi, hastaneye kabule karar vermek, terapötik ihtiyaçları ve seçenekleri belirlemek için acilen hastalık şiddetinin değerlendirilmesi gerektirmektedir. Bu çalışma, COVID-19 pnömonisi olan geriatrik grupta ve diğer COVID-19 olmayan pnömonilerle mortalite riskini değerlendirmek için CURB-65 skorlama sistemi ve pnömoni şiddet indeksinin (PSI) etkinliğini karşılaştırdı.
Yöntemler: COVID-19 laboratuvar teyidi için başvuran 21.134 hasta arasından, bilgisayarlı tomografi taramalarında buzlu cam yoğunlukları görülen 65 yaş ve üzeri 527 hasta seçildi. Tüm demografik, klinik ve laboratuvar verileri retrospektif olarak tarandı ve COVID-19 pnömonisi olan veya COVID-19 dışı pnömonisi olan hastalar seçilip takip edildi.
Bulgular: Tüm hastalar arasında genel ölüm oranı %25,6, COVID-19 pnömonisi olan hastalarda oran %14,3 ve COVID-19 dışı pnömonisi olan hastalarda oran %29,2 idi. ROC analizi, COVID-19 hastaları arasında PSI>grup III'ün mortaliteyi tahmin etmede %77.8 duyarlılık, %73.2 özgüllük, %32.6 PPV, %95.2 NPV’idi. (AUC:0.800, %95 GA: 0.720-0.866; P<0,0001).

CURB-65 skoru >2 olan COVID-19 pnömoni hastalarında mortaliteyi tahmin etmede duyarlılık %66,7, PPV %60 özgüllük ve NPV %94,3 idi. (EAA: 0,857, %95 GA: 0,783–0,913; P<0,0001).
Sonuç: PSI skoru üçten büyük ve CURB-65 skoru ikiden büyük olan COVID-19 ve COVID-19 olmayan enfeksiyonlara sahip pnömoni hastaları için mortalite tahmininde güçlü skorlamalardır. Geriatrik hastaların kabul ve yatışlarına göre sınıflandırılmasında her bir skorlama sisteminin avantajları vardır.

Anahtar Kelimeler

CURB-65, COVID-19, Geriyatri, Pnömoni, Pnömoni şiddet indeksi, mortalite

Kaynakça

1. WHO, Data last updated: February 25, 2022. Available at: https://covid19.who.int/. Accessed February 25, 2022.
2. Pan A, Liu L, Wang C, et al. Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China. JAMA. 2020;323(19):1915-23.
3. Satici C, Demirkol MA, Sargin Altunok E, et al. Performance of pneumonia severity index and CURB-65 in predicting 30-day mortality in patients with COVID-19. Int J Infect Dis. 2020;98:84-9.
4. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243-50.
5. Guo J, Zhou B, Zhu M, et al. CURB-65 may serve as a useful prognostic marker in COVID-19 patients within Wuhan, China: a retrospective cohort study. Epidemiol Infect. 2020;148:e241.
6. Singanayagam A, Chalmers JD. Severity assessment scores to guide empirical use of antibiotics in community acquired pneumonia. Lancet Respir Med. 2013;1(8):653-62.
7. Zhou F, Wang Y, Liu Y, et al. Disease severity and clinical outcomes of community-acquired pneumonia caused by non-influenza respiratory viruses in adults: a multicentre prospective registry study from the CAP-China Network. Eur Respir J. 2019;54(2):1802406. 8. Oktariani, Pitoyo CW, Singh G, et al. CURB 65 score as a predictor of early mortality in hospital-acquired pneumonia. Egypt J Chest Dis Tuberc 2019;68 (2):231-5
9. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020;395(10229):1054-62.
10. Bilim Kurulu Çalışması. COVID-19 (SARS-CoV-2 enfeksiyonu) Rehberi. TC. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü (2 Nisan 2020) Ankara. 2020. Available at: https://covid19rehberi.com/wp-content/uploads/2020/04/COVID19_Eriskin_Hasta_Tedavisi_02042020.pdf Accessed February 20, 2021.
11. Liu K, Chen Y, Lin R, et al. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18.
12. WHO. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance. 2020b. January 2, 2020. Available at:https://www.who.int/publications/i/item/10665-332299 Accessed December 15, 2021.
13. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377-82.
14. Pondaven-Letourmy S, Alvin F, Boumghit Y, et al. How to perform a nasopharyngeal swab in adults and children in the COVID-19 era. Eur Ann Otorhinolaryngol Head Neck Dis. 2020;137(4):325-7.
15. Ji Y, Ma Z, Peppelenbosch MP, et al. Potential association between COVID-19 mortality and health-care resource availability. Lancet Glob Health. 2020;8(4):e480.
16. Giacomelli A, Ridolfo AL, Milazzo L, et al. 30-day mortality in patients hospitalized with COVID-19 during the first wave of the Italian epidemic: A prospective cohort study. Pharmacol Res. 2020;158:104931.
17. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020 Jan 30;:]. Lancet. 2020;395(10223):497-506.
18. Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China [published correction appears in JAMA Intern Med. 2020 Jul 1;180(7):1031]. JAMA Intern Med. 2020;180(7):934-43.
19. Görgülü, O., Duyan, M. Effects of Comorbid Factors on Prognosis of Three Different Geriatric Groups with COVID-19 Diagnosis. SN Compr. Clin. Med. (2020). 2, 2583–94
20. Bulut C, Kato Y. Epidemiology of COVID-19. Turk J Med Sci. 2020;50(SI-1):563-570. Published 2020 Apr 21. doi:10.3906/sag-2004-172
21. Aksel G, İslam MM, Algın A, et al. Early predictors of mortality for moderate to severely ill patients with Covid-19. Am J Emerg Med. 2021;45:290-6.
22. Wynants L, Van Calster B, Collins GS, et al. Prediction models for diagnosis and prognosis of covid-19: systematic review and critical appraisal BMJ 2020; 369 :m1328
23. Wang L. C-reactive protein levels in the early stage of COVID-19. Med Mal Infect. 2020;50(4):332-4.
24. Ciceri F, Castagna A, Rovere-Querini P, et al. Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy. Clin Immunol. 2020;217:108509.
25. Bastug A, Bodur H, Erdogan S, et al. Clinical and laboratory features of COVID-19: Predictors of severe prognosis. Int Immunopharmacol. 2020;88:106950.
26. Bedel C, Selvi F. Association of Platelet to Lymphocyte and Neutrophil to Lymphocyte Ratios with In-Hospital Mortality in Patients with Type A Acute Aortic Dissection. Braz J Cardiovasc Surg. 2019;34(6):694-8.
27. Angkananard T, Anothaisintawee T, McEvoy M, et al. Neutrophil Lymphocyte Ratio and Cardiovascular Disease Risk: A Systematic Review and Meta-Analysis. Biomed Res Int. 2018;2018:2703518.
28. Yadaw AS, Li YC, Bose S, et al. Clinical predictors of COVID-19 mortality. Preprint. medRxiv. 2020;2020.05.19.20103036.
29. Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145-51.
30. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42.
31. Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy [published correction appears in JAMA. 2020;323(16):1574-81.
32. Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol. 2020;92(4):441-7.

Evaluation of Mortality Risk with CURB-65 and PSI in Patients with and Without Geriatric COVID-19 Pneumonia

Yıl 2022, Cilt: 5 Sayı: 1, 8 - 22, 30.04.2022

Murat Duyan Resmiye Nur Okudan

Öz

Aim: The evaluation and management of pneumonia resulting from the infections of coronavirus disease 2019 (COVID-19) urgently require assessing disease severity to decide on the hospital admission and determine the therapeutic needs and options. This study compared the effectiveness of the CURB-65 scoring system and pneumonia severity index (PSI) to evaluate the mortality risk in the geriatric group having COVID-19 pneumonia and with other non-COVID-19 pneumonia.
Methods: 527 patients in ages 65 years or older, whose computerized tomography scans showed ground glass densities, were selected among 21,134 patients who applied for laboratory confirmation of COVID-19. All demographic, clinical, and laboratory data were retrospectively scanned, and selected patients having COVID-19 pneumonia or non-COVID-19 pneumonia were followed up.
Results: The overall mortality rate among all patients was 25.6%, the ratio of the patients having COVID-19 pneumonia was 14.3%, and the ratio of patients having non-COVID-19 pneumonia was 29.2%. ROC analysis showed that PSI>group III among COVID-19 patients had an effective discriminative effectiveness in predicting mortality with 77.8% sensitivity, 73.2% specificity, PPV 32.6%, NPV 95.2% (AUC:0.800, 95% CI: 0.720–0.866; P<0.0001). In predicting mortality in COVID-19 pneumonia patients with a CURB-65 score >2, sensitivity was 66.7%, PPV 60% specificity, and NPV 94.3% (AUC: 0.857, 95% CI: 0.783–0.913; P<0.0001).
Conclusions: For pneumonia patients with a PSI score greater than three and CURB-65 score greater than two, COVID-19 and non-COVID-19 infections are powerful scores in predicting mortality. Each scoring system has its advantages in stratifying geriatric patients on admission and hospitalization.

Anahtar Kelimeler

COVID-19, CURB-65, geriatric, pneumonia, pneumonia severity index, mortality

Kaynakça

1. WHO, Data last updated: February 25, 2022. Available at: https://covid19.who.int/. Accessed February 25, 2022.
2. Pan A, Liu L, Wang C, et al. Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China. JAMA. 2020;323(19):1915-23.
3. Satici C, Demirkol MA, Sargin Altunok E, et al. Performance of pneumonia severity index and CURB-65 in predicting 30-day mortality in patients with COVID-19. Int J Infect Dis. 2020;98:84-9.
4. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243-50.
5. Guo J, Zhou B, Zhu M, et al. CURB-65 may serve as a useful prognostic marker in COVID-19 patients within Wuhan, China: a retrospective cohort study. Epidemiol Infect. 2020;148:e241.
6. Singanayagam A, Chalmers JD. Severity assessment scores to guide empirical use of antibiotics in community acquired pneumonia. Lancet Respir Med. 2013;1(8):653-62.
7. Zhou F, Wang Y, Liu Y, et al. Disease severity and clinical outcomes of community-acquired pneumonia caused by non-influenza respiratory viruses in adults: a multicentre prospective registry study from the CAP-China Network. Eur Respir J. 2019;54(2):1802406. 8. Oktariani, Pitoyo CW, Singh G, et al. CURB 65 score as a predictor of early mortality in hospital-acquired pneumonia. Egypt J Chest Dis Tuberc 2019;68 (2):231-5
9. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020;395(10229):1054-62.
10. Bilim Kurulu Çalışması. COVID-19 (SARS-CoV-2 enfeksiyonu) Rehberi. TC. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü (2 Nisan 2020) Ankara. 2020. Available at: https://covid19rehberi.com/wp-content/uploads/2020/04/COVID19_Eriskin_Hasta_Tedavisi_02042020.pdf Accessed February 20, 2021.
11. Liu K, Chen Y, Lin R, et al. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18.
12. WHO. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance. 2020b. January 2, 2020. Available at:https://www.who.int/publications/i/item/10665-332299 Accessed December 15, 2021.
13. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377-82.
14. Pondaven-Letourmy S, Alvin F, Boumghit Y, et al. How to perform a nasopharyngeal swab in adults and children in the COVID-19 era. Eur Ann Otorhinolaryngol Head Neck Dis. 2020;137(4):325-7.
15. Ji Y, Ma Z, Peppelenbosch MP, et al. Potential association between COVID-19 mortality and health-care resource availability. Lancet Glob Health. 2020;8(4):e480.
16. Giacomelli A, Ridolfo AL, Milazzo L, et al. 30-day mortality in patients hospitalized with COVID-19 during the first wave of the Italian epidemic: A prospective cohort study. Pharmacol Res. 2020;158:104931.
17. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020 Jan 30;:]. Lancet. 2020;395(10223):497-506.
18. Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China [published correction appears in JAMA Intern Med. 2020 Jul 1;180(7):1031]. JAMA Intern Med. 2020;180(7):934-43.
19. Görgülü, O., Duyan, M. Effects of Comorbid Factors on Prognosis of Three Different Geriatric Groups with COVID-19 Diagnosis. SN Compr. Clin. Med. (2020). 2, 2583–94
20. Bulut C, Kato Y. Epidemiology of COVID-19. Turk J Med Sci. 2020;50(SI-1):563-570. Published 2020 Apr 21. doi:10.3906/sag-2004-172
21. Aksel G, İslam MM, Algın A, et al. Early predictors of mortality for moderate to severely ill patients with Covid-19. Am J Emerg Med. 2021;45:290-6.
22. Wynants L, Van Calster B, Collins GS, et al. Prediction models for diagnosis and prognosis of covid-19: systematic review and critical appraisal BMJ 2020; 369 :m1328
23. Wang L. C-reactive protein levels in the early stage of COVID-19. Med Mal Infect. 2020;50(4):332-4.
24. Ciceri F, Castagna A, Rovere-Querini P, et al. Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy. Clin Immunol. 2020;217:108509.
25. Bastug A, Bodur H, Erdogan S, et al. Clinical and laboratory features of COVID-19: Predictors of severe prognosis. Int Immunopharmacol. 2020;88:106950.
26. Bedel C, Selvi F. Association of Platelet to Lymphocyte and Neutrophil to Lymphocyte Ratios with In-Hospital Mortality in Patients with Type A Acute Aortic Dissection. Braz J Cardiovasc Surg. 2019;34(6):694-8.
27. Angkananard T, Anothaisintawee T, McEvoy M, et al. Neutrophil Lymphocyte Ratio and Cardiovascular Disease Risk: A Systematic Review and Meta-Analysis. Biomed Res Int. 2018;2018:2703518.
28. Yadaw AS, Li YC, Bose S, et al. Clinical predictors of COVID-19 mortality. Preprint. medRxiv. 2020;2020.05.19.20103036.
29. Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145-51.
30. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42.
31. Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy [published correction appears in JAMA. 2020;323(16):1574-81.
32. Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol. 2020;92(4):441-7.

Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	Klinik Tıp Bilimleri
Bölüm	Makaleler
Yazarlar	Murat Duyan 0000-0002-6420-3259 Resmiye Nur Okudan 0000-0003-4187-7928
Yayımlanma Tarihi	30 Nisan 2022
Kabul Tarihi	7 Nisan 2022
Yayımlandığı Sayı	Yıl 2022 Cilt: 5 Sayı: 1

Kaynak Göster

APA	Duyan, M., & Okudan, R. N. (2022). Evaluation of Mortality Risk with CURB-65 and PSI in Patients with and Without Geriatric COVID-19 Pneumonia. Journal of Cukurova Anesthesia and Surgical Sciences, 5(1), 8-22.

Kapak Resmi İndir

Makale Dosyaları

Tam Metin

https://dergipark.org.tr/tr/download/journal-file/11303