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Risk models for predicting in-hospital mortality from COVID-19 pneumonia in the elderly




L√≥pez-Izquierdo R, Ruiz Albi T, Bermejo-Mart√≠n JF, Almansa R, Villafa√Īe Sanz FV, Arroyo Olmedo L, Urbina Carrera CA, S√°nchez Ram√≥n S, Mart√≠n-Rodr√≠guez F, Moreno Torrero F, √Ālvarez D, Del Campo Mat√≠a F



Servicio de Urgencias, Hospital Universitario Río Hortega, Valladolid, Spain. Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Spain. Servicio de Neumología, Hospital Universitario Río Hortega, Valladolid, Spain. Grupo de Investigación Biomédica en Infección Respiratoria y Sepsis (Biosepsis) (IBSAL), Spain. Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Spain. Unidad Móvil de Emergencias, Gerencia de Emergencias Sanitarias de Castilla y León (SACYL), Spain. Centro de Simulación Clínica Avanzada, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain. Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain. Grupo de Ingeniería Biomédica (GIB), Universidad de Valladolid, Valladolid, Spain.



Objective. To compare the prognostic value of 3 severity scales: the Pneumonia Severity Index (PSI), the CURB-65 pneumonia severity score, and the Severity Community-Acquired Pneumonia (SCAP) score. To build a new predictive model for in-hospital mortality in patients over the age of 75 years admitted with pneumonia due to the coronavirus disease 2019 (COVID-19).
Methods. Retrospective study of patients older than 75 years admitted from the emergency department for COVID-19 pneumonia between March 12 and April 27, 2020. We recorded demographic (age, sex, living in a care facility or not), clinical (symptoms, comorbidities, Charlson Comorbidity Index [CCI]), and analytical (serum biochemistry, blood gases, blood count, and coagulation factors) variables. A risk model was constructed, and the ability of the 3 scales to predict all-cause in-hospital mortality was compared.
Results. We included 186 patients with a median age of 85 years (interquartile range, 80‚Äď89 years); 44.1% were men. Mortality was 47.3%. The areas under the receiver operating characteristic curves (AUCs) were as follows for each tool: PSI, 0.74 (95% CI, 0.64‚Äď0.82); CURB-65 score, 0.71 (95% CI, 0.62‚Äď0.79); and SCAP score, 0.72 (95% CI, 0.63‚Äď0.81). Risk factors included in the model were the presence or absence of symptoms (cough, dyspnea), the CCI, and analytical findings (aspartate aminotransferase, potassium, urea, and lactate dehydrogenase. The AUC for the model was 0.81 (95% CI, 0.73‚Äď0.88).
Conclusions. This study shows that the predictive power of the PSI for mortality is moderate and perceptibly higher than the CURB-65 and SCAP scores. We propose a new predictive model for mortality that offers significantly better performance than any of the 3 scales compared. However, our model must undergo external validation.


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