FluA-p score: a novel prediction rule for mortality in influenza A-related pneumonia patients [post]

Liang Chen, Xiudi Han, YanLi Li, Chunxiao Zhang, Xiqian Xing
2020 unpublished
Background The pneumonia severity index (PSI) and the CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) score have been shown to predict mortality in community-acquired pneumonia. Their ability to predict influenza-related pneumonia, however, is less well-established. Methods A total of 693 laboratory-confirmed FluA-p patients diagnosed between Jan 2013 and Dec 2018 and recruited from five teaching hospitals in China were included in the study. The sample included 494
more » ... ample included 494 patients in the derivation cohort and 199 patients in the validation cohort. The prediction rule was established based on independent risk factors for 30-day mortality in FluA-p patients from the derivation cohort. Results The 30-day mortality of FluA-p patients was 19.6% (136/693). The FluA-p score was based on a multivariate logistic regression model designed to predict mortality. Results indicated the following significant predictors (regression statistics and point contributions toward total score in parentheses): blood urea nitrogen > 7 mmol/L ( OR 1.604, 95% CI 1.150-4.492, p = 0.040; 1 points), pO 2 /F i O 2 ≤ 250 mmHg ( OR 2.649, 95% CI 1.103-5.142, p = 0.022; 2 points), cardiovascular disease ( OR 3.967, 95% CI 1.269-7.322, p <0.001; 3 points), arterial PH < 7.35 ( OR 3.959, 95% CI 1.393-7.332, p < 0.001; 3 points), smoking history ( OR 5.176, 95% CI 2.604-11.838, p = 0.001; 4 points), lymphocytes < 0.8×10 9 /L ( OR 8.391, 95% CI 3.271-16.212, p <0.001; 5 points), and early neurominidase inhibitor therapy ( OR 0.567, 95% CI 0.202-0.833, p = 0.005; -2 points). Seven points was used as the cut-off value for mortality risk stratification. The model showed a sensitivity of 0.941, a specificity of 0.762, and overall better predictive performance than the PSI risk class (AUROC = 0.908 vs 0.560, p < 0.001) and the CURB-65 score (AUROC = 0.908 vs 0.777, p < 0.001). Conclusions Our results showed that a FluA-p score was easy to derive and that it served as a reliable prediction rule for 30-day mortality in FluA-p patients. The score could also effectively stratify FluA-p patients into relevant risk categories and thereby help treatment providers to make more rational clinical decisions.
doi:10.21203/rs.2.23663/v2 fatcat:wezli7hlrbamrnebnbgvsewubi