MuLBSTA Score for Viral Pneumonia Mortality

MuLBSTA Calculator

Multilobar infiltrates on chest imaging

Lymphocyte count ≤0.8 ×10⁹/L

Bacterial coinfection

Smoking history (current or former)

Hypertension

Age ≥60 years

MuLBSTA Score: 0

Low Risk

MuLBSTA Score: 0. Low mortality risk (<5%) from viral pneumonia.

Predicts 90-day mortality in patients with viral pneumonia.

Why Use

Predicts risk factors for mortality that may be unique to viral PNA. The MuLBSTA score examines a patient population with similar characteristics to those with COVID-19 PNA, and has inputs similar to risk factors for mortality seen in the initial COVID-19 patient cohorts out of China.

When to Use

In patients with viral pneumonia, to predict clinical characteristics that affect mortality.

Formula

Addition of the selected points: Variable Points Mu ltilobe infiltrate Yes 5 No 0 Absolute L ymphocyte count ≤0.8 x 10 9 /L Yes 4 No 0 B acterial coinfection (detected by sputum or blood culture) Yes 4 No 0 S moking history Non smoker 0 Prior smoker 2 Active smoker 3 History of hyper- T ension Yes 2 No 0 A ge ≥60 years Yes 2 No 0

Pearls / Pitfalls

Designed specifically for viral pneumonia, which may account for up to 29% of CAP ( Jennings 2008 ). Virus-associated pneumonia is defined as lower respiratory infection with a positive PCR for viral antigen. This single-center, retrospective, not-externally-validated design may lead to bias and unknown applicability and generalizability. If used on COVID-19 PNA patients, keep in mind that age has a much stronger odds ratio for increasing mortality risk in COVID-19 patients than with other viral PNA patients.

Critical Actions

If applying to a patient with potential COVID-19, use this score in conjunction with clinical suspicion and risk factors - particularly advanced age and comorbidities.

Advice

Threshold for disposition may change during resource-limited situations such as the current COVID-19 outbreak. Take into consideration that the upper limit of the “low risk” group as indicated in the original study still carries a relatively high mortality rate (e.g. 11 points = 12.27% mortality).

More Information

Interpretation: MuLBSTA Score 90-day mortality 0 0.47% 2 0.87% 3 1.18% 4 1.60% 5 2.17% 6 2.92% 7 3.93% 8 5.27% 9 7.03% 10 9.33% 11 12.27% 12 15.99% 13 20.56% 14 26.03% 15 32.36% 16 39.42% 17 46.95% 18 54.61% 19 62.07% 20 68.99%