Prognostic Value of Integrated Pulmonary Index (IPI) Value in Determining Pneumonia Severity in Patients Diagnosed with COVID-19 Pneumonia in the Emergency Department

Year 2023, , 62 - 71, 28.02.2023

Ezgi Sumer , Gülşah Çıkrıkçı Işık , Şeref Kerem Çorbacıoğlu , Yunsur Çevik

https://doi.org/10.19127/mbsjohs.1192663

Abstract

Objective: This study aimed to examine the predictive power regarding prognosis of the Integrated Pulmonary Index (IPI) values measured at admission for patients diagnosed with COVID-19 pneumonia in the emergency department. In addition, the correlation between CURB-65 and PSI scores and IPI values in COVID-19 pneumonia was also examined.

Methods: The study was conducted between April 2020 and December 2020 as a prospective study. We evaluated respiratory function using IPI monitoring system that includes oxygen saturation, end-tidal CO2, respiratory rate, and pulse rate. For patients diagnosed with COVID-19 pneumonia in the emergency department, the IPI value was measured at the time of admission and PSI and CURB-65 scores were calculated. The predictive power of the IPI value in patients with clinical severity and the correlations between clinical severity and PSI, CURB-65 and IPI scores were examined. All of the data that was obtained during the study was recorded in the study form and evaluated using the IBM SPSS 22.0 statistical program in which P <0.05 was considered to be statistically significant.

Results: A total of 81 patients were included in the study. When the severity of pneumonia was compared with the CURB-65, PSI and IPI values, a statistically significant difference was found between the clinical severity groups for all scores (p<0.001 for each score). Although the correlation between clinical severity, CURB-65 and PSI scores was positive and moderate (r:0.556 and r:0.613, respectively), the correlation between clinical severity and IPI value was found to be inverse and strong (r:0.824). While the IPI value was green, the sensitivity to predict mild pneumonia was 94.92%, and the specificity was 54.55%.

Conclusion: Although all of the scores showed a significant correlation with clinical severity in patients with COVID-19 pneumonia, this correlation was moderate in PSI and CURB-65 scores, while there was a strong inverse correlation between IPI value and clinical severity. Considering the ease of use of the IPI value and its correlation with the clinic, we believe that it is more successful than CURB-65 and PSI scores in predicting clinical severity in patients with COVID-19 pneumonia.

Keywords

COVID-19 pneumonia, integrated pulmonary index, pneumonia severity index, CURB-65

References

• 1. Ronen M, Weissbrod R, Overdyk FJ, Ajizian S. Smart respiratory monitoring: clinical development and validation of the IPI™ (Integrated Pulmonary Index) algorithm. J Clin Monit Comput. 2017;31(2):435-442.
• 2. Pulia MS, O’Brien TP, Hou PC, Schuman A, Sambursky R. Multi-tiered screening and diagnosis strategy for COVID-19: a model for sustainable testing capacity in response to pandemic. Ann Med. 2020;52(5):207–14.
• 3. Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-acquired pneumonia requiring hospitalization among US adults. N Engl J Med. 2015;373(5):415-427.
• 4. Turkish Republic Ministry of Health, General Directorate of Public Health, COVID-19 adult patient treatment quideline. Accessed: Dec 6, 2021. [Online]. Available: https://covid19.saglik.gov.tr/Eklenti/40719/0/covid-19rehberieriskinhastayonetimivetedavipdf.pdf
• 5. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149-60.
• 6. Ucan ES, Ozgen Alpaydin A, Ozuygur SS, Ercan S, Unal B, Sayiner AA, et al. Pneumonia severity indices predict prognosis in coronavirus disease-2019. Respir Med Res. 2021;79:100826. doi:10.1016/j.resmer.2021.100826
• 7. Artero A, Madrazo M, Fernández-Garcés M, Miguez AM, Garcia AG, Vieitez AC, et al. Severity Scores in COVID-19 Pneumonia: a Multicenter, Retrospective, Cohort Study. J Gen Intern Med. 2021;36(5):1338-1345.
• 8. Falcone M, Corrao S, Venditti M, Serra P, Licata G. Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia [published correction appears in Intern Emerg Med. 2013;8(6):549]. Intern Emerg Med. 2011;6(5):431-436.
• 9. Anurag A, Preetam M. Validation of PSI/PORT, CURB-65 and SCAP scoring system in COVID-19 pneumonia for prediction of disease severity and 14-day mortality. Clin Respir J. 2021;15(5):467-471.
• 10. Elmoheen A, Abdelhafez I, Salem W, Bahgat M, Elkandow A, Tarig A, et al. External Validation and Recalibration of the CURB-65 and PSI for Predicting 30-Day Mortality and Critical Care Intervention in Multiethnic Patients with COVID-19. Int J Infect Dis. 2021;111:108-116.
• 11. Holten AR, Nore KG, Tveiten CEVWK, Olasveengen TM, Tonby K. Predicting severe COVID-19 in the Emergency Department. Resusc Plus. 2020;4:100042.
• 12. Arnold FW, Ramirez JA, McDonald LC, Xia EL. Hospitalization for community-acquired pneumonia: the pneumonia severity index vs clinical judgment. Chest. 2003;124(1):121-124.
• 13. Lim WS, van der Eerden MM, Laing R, Boersma WG, Kralus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377-382.
• 14. Aliberti S, Ramirez J, Cosentini R, Brambilla AM, Zanaboni AM, Rossetti V, et al. Low CURB-65 is of limited value in deciding discharge of patients with community-acquired pneumonia. Respir Med. 2011;105(11):1732-1738.