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

espanolObjetivo. Los objetivos son comparar la utilidad pronostica de tres escalas de gravedad (Pneumonia Severity Index: PSI; CURB-65 scale; Severity Community Acquired Pneumonia Score: SCAP) y disenar un nuevo modelo predictivo de mortalidad hospitalaria en pacientes mayores de 75 anos ingresados por neumonia por COVID-19. Metodo. Estudio retrospectivo de pacientes mayores de 75 anos ingresados por neumonia por COVID-19 desde el servicio de urgencias entre el 12 de marzo y el 27 de abril de 2020. Se recogieron variables demograficas (edad, sexo, institucionalizacion), clinicas (sintomas, comorbilidades, indice de Charlson) y analiticas (bioquimica en suero, gasometria, hematimetria, hemostasia). Se derivo un modelo de riesgo y se compararon las escalas de gravedad PSI, CURB-65 y SCAP para predecir la mortalidad intrahospitalaria por cualquier causa. Resultados. Se incluyeron 186 pacientes, con una mediana de edad de 85 anos (RIC 80-89), un 44,1% varones. La mortalidad fue del 47,3%. Las escalas PSI, CURB-65 y SCAP tuvieron un area bajo la curva (ABC) de 0,74 (IC 95% 0,64-0,82), 0,71 (IC 95% 0,62-0,79) y 0,72 (IC 95% 0,63-0,81), respectivamente. El modelo predictivo compuesto por la ausencia o presencia de sintomas (tos y disnea), comorbilidad (indice de Charlson) y datos analiticos (asparta-to-aminotransferasa, potasio, urea y lactato-deshidrogenasa) tuvo un ABC de 0,81 (IC 95% 0,73-0,88). Conclusion. Este estudio muestra que la escala PSI tiene una capacidad predictiva de mortalidad moderada, notable-mente mejor que las escalas CURB-65 y SCAP. Se propone un nuevo modelo predictivo de mortalidad que mejora significativamente el rendimiento de estas escalas, siendo necesario verificar su validez externa. EnglishObjective. 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, 80–89 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, 0.64–0.82); CURB-65 score, 0.71 (95% CI, 0.62–0.79); and SCAP score, 0.72 (95% CI, 0.63–0.81). 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, 0.73–0.88). 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.