Admission data used to identify low-risk pneumonia in patients hospitalized with COVID-19

In a new study, data made available upon admission identified about 80% of patients with COVID-19 who had low-risk pneumonia.

“The primary aim of the current study was to identify factors for low-risk SARS-CoV-2 pneumonia that will not require ICU admission ... or lead to death during hospitalization, with the use of clinical and biochemical data obtained in the ED and the Infectious Diseases Society of America/ATS minor criteria for ICU admission in community-acquired pneumonia,” Rosario Menéndez, MD, PhD, from the department of pulmonology at La Fe University and Polytechnic Hospital, the Health Research Institute La Fe at the University of Valencia, Spain, and the Center for Biomedical Research Network in Respiratory Diseases, Madrid, and colleagues wrote in Chest.

The multicenter cohort study included 1,274 patients in a derivation cohort and 1,584 in two validation cohorts (830 in the first wave; 754 in the second wave). Researchers analyzed the derivation cohort and compared patients admitted to the general ward who were assessed as low risk, patients admitted directly to the ICU, patients transferred to the ICU after general ward admission and patients who died during the study period. Using the Infectious Diseases Society of America (IDSA)/ATS minor criteria for ICU admission and the CURB-65 score, researchers conducted initial assessments of disease severity for all patients.

In the derivation cohort, 12.2% of patients died, 9.1% were treated in general wards, 22.7% were directly admitted to the ICU and 25.2% were transferred to the ICU. About 15% of patients died in the first wave in the validation cohort and 7.1% died in the second wave in the validation cohort.

Researchers observed similarities among patients who were directly admitted or transferred to the ICU and patients who died.

The researchers identified five independent factors as predictors of low-risk pneumonia, which was defined as no death or ICU admission: Peripheral blood oxygen saturation/fraction of inspired oxygen (SpO₂/FiO₂) more than 450, less than three IDSA/ATS minor criteria, lymphocyte count of more than 732 cells/mL, urea level of less than 40 mg/dL and C-reactive protein levels less than 60 mg/L were identified as independently associated factors that predict low risk SARS-CoV-2.

Areas under the curve were 0.802 for the derivation cohort, 0.779 for the first wave of the validation cohort and 0.801 for the second wave of the validation cohort (P < .001 for all).

“Early identification of patients with low-risk SARS-CoV-2 pneumonia who will not require ICU admission and/or progress to death could help with resource allocation during periods of hospital bed shortages,” the researchers wrote.