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

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

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

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

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