Development of a model for the differential diagnosis of community-acquired bacterial pneumonia and viral lung injury in hospitalized adult patients

• Published in: Kachestvennai͡a︡ klinicheskai͡a︡ praktika no. 4; pp. 78 - 85
• Main Authors: Kupriushina, O. A., Strelkova, D. A., Yasneva, A. S., Rachina, S. A., Avdeev, S. N., Vlasenko, A. E., Fedina, L. V., Ivanova, O. V., Kaledina, I. V., Ananicheva, N. A.
• Format: Journal Article
• Language: English; Russian
• Published: Izdatelstvo OKI 28-02-2024
• Subjects: covid-19; sars-cov-2; внебольничная бактериальная пневмония
• ISSN: 2588-0519; 2618-8473
• DOI: 10.37489/2588-0519-2023-4-78-85

Relevance.
During and after the COVID-19 pandemic, viruses have become a more common cause of pulmonary infections in adults; therefore, the distinction between viral lung injury and community-acquired bacterial pneumonia is of increasing importance.
Aim.
Development of a model for differentiating community-acquired bacterial pneumonia and viral lung injury, including COVID-19.
Materials and methods.
This retrospective case–control study included 300 adult patients with viral lung injury and 100 adult patients with community-acquired bacterial pneumonia. Clinical, laboratory, and instrumental data were analyzed, significant factors were selected by which the samples differed, and a model was developed using logistic regression to distinguish between community-acquired bacterial pneumonia and viral lung damage, including COVID-19.
Results.
The developed model included the following parameters: total protein level, neutrophil/lymphocyte index, heart rate, unilateral infiltration on CT or chest x-ray, vasopressor prescription in the first 24 h of hospitalization, altered level of consciousness, chills, and fatigue. The model had the following characteristics: AUC = 0.94 (0.92–0.96), AUC_PR = 0.84 (0.76 to 0.92), prediction accuracy — 90%, sensitivity — 76%, specificity — 95%, positive predictive value — 83 %.
Conclusion.
The use of this model can facilitate the differential diagnosis of community-acquired bacterial pneumonia and viral lung injury, including COVID-19, in adults in general wards and intensive care units.