SESSION TITLE: Respiratory Infections: What have We Learned About COVID-19 and New Trial Data for Management of Aspergilloma
SESSION TYPE: Original Investigations
PRESENTED ON: October 18-21, 2020
PURPOSE: An influx of SARS-COV2 infection has led to several unanswered questions, one such question raised was how to risk stratify these patients in order to better direct further management. The MuLBSTA score recently developed by Guo L. et al. in Shanghai, China is designed to predict 90-day mortality in patients with viral pneumonia. Since very little is known regarding patients with SARS COV-2 infection and COVID-19 disease, we aim to explore the applicability of MuLBSTA score in predicting disease severity and risk of mortality in these patients.
METHODS: A single centre, retrospective chart review of one-hundred and sixty-three hospitalized patients with COVID-19 pneumonia at a community hospital in Michigan from March 15 to April 10, 2020. Several clinical characteristics were reviewed, six risk factors were incorporated into the MulBSTA score which included: multilobe infiltrate, absolute lymphocyte count ≤0.8 x 109/L, bacterial coinfection, smoking history, history of hypertension and age ≥ 60 years. The calculated score was then compared to the primary outcome of mortality and secondary outcomes which included length of stay and ventilator support. Data collected was then analysed using SPSS, validity of the data was analyzed using regression analysis and receiver operating characteristic curve.
RESULTS: A total of 163 patients were manually reviewed, of which there was an overall mortality rate of 29.4%, an ICU mortality rate of 50.9% and ventilator associated mortality of 62.8%. The MuLBSTA score was applied to each patient manually at time of hospitalization. There was a mean MuLBSTA score of 8.67 (4.066) for patients who survived and a mean MuLBSTA score of 13.6 (1.87) for patients who died. There was a significant positive correlation of the MuLBSTA score with mortality (OR = 1.37, 95% CI 1.23-1.53, p = .0001). The area under the receiver operating characteristic (ROC) curve of MuLBSTA for predicting in-hospital mortality at time of admission was 0.813(SE 0.037). A positive correlation was also found with ventilator support (OR= 1.30, 95% CI 1.17-1.44, p= .0001) and length of stay (r (161) =.35, p=.0001).
CONCLUSIONS: Analysis of data indicated that in patients with COVID-19 pneumonia, the MuLBSTA score successfully stratified hospitalized patients based on severity and accurately predicted overall outcome.
CLINICAL IMPLICATIONS: This score correlated significantly with mortality, ventilator support and length of stay, which may be used to provide guidance to screen patients and make further clinical decisions. Further studies are required to validate this study in larger patient cohorts.
DISCLOSURES: No relevant relationships by Verisha Khanam, source=Web Response
No relevant relationships by Sarwan Kumar, source=Web Response
No relevant relationships by vesna tegeltija, source=Web Response
No relevant relationships by Jurgena Tusha, source=Web Response
© 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.