Comparison of Prognostic Scoring Systems in Patients with COVID-19 Pneumonia: The Role of PSI, CURB-65, DECAF, and PRIEST Scores in Predicting Mortality and Clinical Outcomes
PSI, CURB-65, DECAF, and PRIEST in COVID-19
DOI:
https://doi.org/10.5281/zenodo.17156150Keywords:
COVID-19, Pneumonia, CURB-65, DECAF Score, MortalityAbstract
Background: Coronavirus Disease 2019 (COVID-19) has caused significant morbidity and mortality worldwide, highlighting the need for reliable prognostic tools to support clinical decision-making. Several scoring systems originally developed for community-acquired pneumonia and other respiratory diseases have been applied in COVID-19; however, their comparative effectiveness remains insufficiently clarified.
Methods: This retrospective observational study included 234 adult patients who presented to the Emergency Department of Ankara Training and Research Hospital between November 2020 and July 2021 with a diagnosis of COVID-19 pneumonia. Demographic characteristics, vital signs, comorbidities, laboratory results, and imaging findings were recorded. Four prognostic scoring systems—the Pneumonia Severity Index (PSI), Confusion, Urea, Respiratory rate, Blood pressure–65 (CURB-65), Dyspnea, Eosinopenia, Consolidation, Acidemia, Atrial fibrillation (DECAF), and Pandemic Respiratory Infection Emergency System Triage (PRIEST)—were calculated. Clinical outcomes were categorized as discharge, ward admission, or intensive care unit admission, and 30-day mortality was assessed. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney U, chi-square, and ROC curve methods.
Results: Of the 234 patients, 108 (46.2%) were male and 126 (53.8%) were female, with a mean age of 61.5 years. Thirty-day mortality was identified in 42 patients (17.9%). Advanced age was significantly associated with mortality (p<0.05). All four scoring systems demonstrated significant associations with both clinical outcomes and 30-day mortality. PSI ≥4 predicted mortality with 88.1% sensitivity and 70% specificity (AUROC: 0.85), whereas PRIEST ≥13 showed the best performance in predicting intensive care unit admission with 86.7% sensitivity and 87.9% specificity (AUROC: 0.93). For discharge, PRIEST ≤9 provided the highest predictive accuracy (sensitivity: 94.8%, specificity: 69.3).
Conclusion: PSI, CURB-65, DECAF, and PRIEST scoring systems were all found to be significant in predicting mortality and clinical outcomes in patients with COVID-19 pneumonia. While PSI was the strongest predictor of mortality, PRIEST demonstrated superior predictive value for intensive care unit admission and discharge. Nevertheless, these scoring systems should be regarded as supportive tools rather than standalone decision-makers and should always be applied in conjunction with clinicians’ judgment.
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Copyright (c) 2025 Dursun Buğra Dereyurt, Düzce Atatrük State Hospital Department of Emergency Medicine, Düzce, Türkiye, Center for Labor and Social Security Training and Research, Ankara, Türkiye, University of Health Sciences, Ankara Training and Research Hospital, Department of Emergency Medicine, Ankara, Türkiye, University of Health Sciences, Ankara Training and Research Hospital, Department of Emergency Medicine, Ankara, Türkiye
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