Comparison of predictive performances of pneumonia scores, qSOFA and 4C mortality score in patients hospitalized for COVID-19: a retrospective study

Abstract

Introduction

Several scores have been validated for predicting mortality in community-acquired pneumonia (CRB-65, CURB-65, PSI), sepsis (qSOFA) and COVID-19 (4C Mortality Score). However, performances of theses scores in pneumonia and COVID-19 as well as the impact of Omicron as predominating virus mutation on prediction performances remained to be determined.

Methods

In this single-center retrospective study, the prognostic value of different scores in the periods pre-omicron (03/20–12/2021) were compared to those of the omicron period (01/2022–03/2023) in patients hospitalized for COVID-19.

Results

Of 622 study patients, 348 (56.2%) had pneumonia. Mortality was 16.2% (101 patients), with a significant difference between periods (71 (23.1%) versus 30 (9.5%), p<0.001). In patients with pneumonia, predictive performance of PSI was significantly better compared to CRB-65, CURB-65 and qSOFA (differences between AUCs PSI vs CRB-65 0.066 (95% CI 0.02–0.11, p=0.006); PSI vs CURB-65 0.047 (95% CI 0–0.09, p=0.042); PSI vs qSOFA 0.124 (95% CI 0.05–0.2, p=0.001) but not when compared to the 4C Mortality Score. There was no difference in predictive performances between periods for any score, also after excluding patients with treatment restrictions.

Conclusions

All scores had good predictive performances for low risk and moderate for mortality in patients with COVID-19, with PSI being the best predictor for patients with pneumonia. 4C Mortality Score was a good predictior in all patients. There were no significant differences between the predictive performances of the scores in pre-omicron and omicron periods of the pandemic.

Zusammenfassung

Einführung

Verschiedene Scores wurden validiert, um die Mortalität einer ambulant erworbenen Pneumonie (CRB-65, CURB-65, PSI), Sepsis (qSOFA) und COVID-19 (4C Mortality Score) abzuschätzen. Die jeweilige Performance dieser Scores bei COVID-19 mit Pneumonie sowie der Einfluss der Omikronvariante auf diese bleibt zu untersuchen.

Methoden

Dies ist eine retrospektive Single-center-Studie, die die prognostische Vorhersagekraft verschiedener Scores insgesamt sowie auf die Phasen vor Omikron (03/2020–12/2021) mit der Omikronphase (01/2022–03/2023) bei Patienten vergleicht, die aufgrund von COVID-19 hospitalisiert worden sind.

Ergebnisse

Von insgesamt 622 Patienten hatten 348 (56,2%) eine Pneumonie. Die Mortalität lag bei insgesamt 16,2% (101 Patienten) mit deutlichem Unterschied zwischen den Phasen (71 (23,1% versus 30 (9,5%), p<0,001). Bei Patienten mit eine Pneumonie hatte der PSI eine signifikant bessere Vorhersagekraft im Vergleich zu CRB-65, CURB-65 und qSOFA (Unterschiede zwischen AUCs PSI vs CRB-65 0,066 (95%-KI 0,02–0,11, p=0,006); PSI vs CURB-65 0,047 (95%-KI 0–0,09, p=0,042); PSI vs qSOFA 0,124 (95%-KI 0,05–0,2, p=0,001). Der 4C Mortality Score zeigte eine ähnliche Vorhersagekraft. Es gab keinen Unterschied der Vorhersagekraft der einzelnen Scores zwischen den definierten Phasen, auch nicht nach Ausschluss der Patienten mit palliativem Therapieziel.

Schlussfolgerung

Alle Scores hatten eine gute Vorhersagekraft für niedrig bis moderates Mortalitätsrisiko bei hospitalisierten Patienten mit COVID-19, wobei der PSI der beste Prädiktor bei Patienten mit Pneumonie war. Der 4C Mortality Score war ein guter Prädiktor bei allen Patienten. Es gab keine signifikanten Unterschiede der Vorhersagekraft der Scores im Vergleich der Phasen der Pandemie.

Keywords

COVID-19 - pneumonia - mortality

Schlüsselwörter

COVID-19 - Pneumonie - Mortalität

Publication History

Received: 19 December 2024

Accepted after revision: 27 March 2025

Article published online:
06 June 2025

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