@article{4334e4a19335406c9ec4ae982baba2c4,
title = "Early Recognition of Low-Risk SARS-CoV-2 Pneumonia: A Model Validated With Initial Data and Infectious Diseases Society of America/American Thoracic Society Minor Criteria",
abstract = "Background: A shortage of beds in ICUs and conventional wards during the COVID-19 pandemic led to a collapse of health care resources. Research Question: Can admission data and minor criteria by the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) help identify patients with low-risk SARS-CoV-2 pneumonia? Study Design and Methods: This multicenter cohort study included 1,274 patients in a derivation cohort and 830 (first wave) and 754 (second wave) patients in two validation cohorts. A multinomial regression analysis was performed on the derivation cohort to compare the following patients: those admitted to the ward (assessed as low risk); those admitted to the ICU directly; those transferred to the ICU after general ward admission; and those who died. A regression analysis identified independent factors for low-risk pneumonia. The model was subsequently validated. Results: In the derivation cohort, similarities existed among those either directly admitted or transferred to the ICU and those who died. These patients could, therefore, be merged into one group. Five independently associated factors were identified as being predictors of low risk (not dying and/or requiring ICU admission) (ORs, with 95% CIs): peripheral blood oxygen saturation/FIO2 > 450 (0.233; 0.149-0.364); < 3 IDSA/ATS minor criteria (0.231; 0.146-0.365); lymphocyte count > 723 cells/mL (0.539; 0.360-0.806); urea level < 40 mg/dL (0.651; 0.426-0.996); and C-reactive protein level < 60 mg/L (0.454; 0.285-0.724). The areas under the curve were 0.802 (0.769-0.835) in the derivation cohort, and 0.779 (0.742-0.816) and 0.801 (0.757-0.845) for the validation cohorts (first and second waves, respectively). Interpretation: Initial biochemical findings and the application of < 3 IDSA/ATS minor criteria make early identification of low-risk SARS-CoV-2 pneumonia (approximately 80% of hospitalized patients) feasible. This scenario could facilitate and streamline health care resource allocation for patients with COVID-19.",
keywords = "COVID-19, IDSA/ATS, SARS-CoV-2, pneumonia, risk profiling",
author = "Rosario Men{\'e}ndez and Ra{\'u}l M{\'e}ndez and Paula Gonz{\'a}lez-Jim{\'e}nez and Rafael Zalacain and Ruiz, {Luis A.} and Leyre Serrano and Espa{\~n}a, {Pedro P.} and Ane Uranga and Catia Cill{\'o}niz and Luis P{\'e}rez-de-Llano and Rafael Golpe and Antoni Torres",
note = "Funding Information: Funding/support: This study was supported by Instituto de Salud Carlos III (ISCIII) through Project [ COV20/00385 ], co-funded by the European Regional Development Fund/European Social Fund “Investing in Your Future.” R. M{\'e}ndez is the recipient of the R{\'i}o Hortega and Juan Rod{\'e}s grants, which are supported by the Instituto de Salud Carlos III [ISCIII (CM19/00182 and JR21/00051, respectively)]. P. G.-J. is the recipient of a post-resident research grant supported by the Health Research Institute La Fe [ 2019-053-1 ]. Funding Information: Author contributions: R. Men{\'e}ndez is the guarantor of the paper. The author contributions were as follows: conceptualization and study design, R. Men{\'e}ndez; patient enrollment and database management, R. M{\'e}ndez, P. G.-J. R. Z. L. A. R. L. S. P. P. E. A. U. C. C. L. P.-d.-L. R. G. and A. T.; and statistical analysis, interpretation of results, and drafting of the manuscript, R. Men{\'e}ndez and R. M{\'e}ndez. All authors revised the manuscript and approved the final version; all authors had full access to all of the data in the study and had the final responsibility of making the decision to submit for publication. All authors approved the final version as submitted. Financial/nonfinancial disclosures: None declared. Funding/support: This study was supported by Instituto de Salud Carlos III (ISCIII) through Project [COV20/00385], co-funded by the European Regional Development Fund/European Social Fund “Investing in Your Future.” R. M{\'e}ndez is the recipient of the R{\'i}o Hortega and Juan Rod{\'e}s grants, which are supported by the Instituto de Salud Carlos III [ISCIII (CM19/00182 and JR21/00051, respectively)]. P. G.-J. is the recipient of a post-resident research grant supported by the Health Research Institute La Fe [2019-053-1]. Role of sponsors: The sponsor had no role in the design of the study, data obtention, analyses, interpretation of results, or drafting. Other contributions: The authors thank the Integrate Research Program of Respiratory Infections of SEPAR. They also extend their thanks to Laura Descalzo, PhD, for her collaboration in the statistical analysis, as well as to Ana Latorre, PhD, and Luz Mimbiela, BS, for their help. Finally, they will always remember those who are no longer among us due to this pandemic. Additional information: The e-Tables are available online under “Supplementary Data.” Publisher Copyright: {\textcopyright} 2022 American College of Chest Physicians",
year = "2022",
month = oct,
doi = "10.1016/j.chest.2022.05.013",
language = "American English",
volume = "162",
pages = "768--781",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "4",
}
