• Rosario Menéndez, Raúl Méndez, Paula González-Jiménez, Rafael Zalacain, Luis A Ruiz, Leyre Serrano, Pedro P España, Ane Uranga, Catia Cillóniz, Luis Pérez-de-Llano, Rafael Golpe, and Antoni Torres.
• Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain; Respiratory Infections, Health Research Institute La Fe, Valencia, Spain; Medicine Department, University of Valencia, Valencia, Spain; Center for Biomedical Research Network in Respiratory Diseases, Madrid, Spain. Electronic address: rosmenend@gmail.com.
• Chest. 2022 Oct 1; 162 (4): 768781768-781.

BackgroundA shortage of beds in ICUs and conventional wards during the COVID-19 pandemic led to a collapse of health care resources.Research QuestionCan 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 MethodsThis 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.ResultsIn 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).InterpretationInitial 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.Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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