Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Intensive Care Unit, Wuhan Tuberculosis Control Institute, Wuhan, China.
Crit Care Med. 2020 Aug;48(8):e657-e665. doi: 10.1097/CCM.0000000000004411.
Coronavirus disease 2019 has emerged as a major global health threat with a great number of deaths in China. We aimed to assess the association between Acute Physiology and Chronic Health Evaluation II score and hospital mortality in patients with coronavirus disease 2019, and to compare the predictive ability of Acute Physiology and Chronic Health Evaluation II score, with Sequential Organ Failure Assessment score and Confusion, Urea, Respiratory rate, Blood pressure, Age 65 (CURB65) score.
Retrospective observational cohort.
Tongji Hospital in Wuhan, China.
Confirmed patients with coronavirus disease 2019 hospitalized in the ICU of Tongji hospital from January 10, 2020, to February 10, 2020.
None.
Of 178 potentially eligible patients with symptoms of coronavirus disease 2019, 23 patients (12.92%) were diagnosed as suspected cases, and one patient (0.56%) suffered from cardiac arrest immediately after admission. Ultimately, 154 patients were enrolled in the analysis and 52 patients (33.77%) died. Mean Acute Physiology and Chronic Health Evaluation II score (23.23 ± 6.05) was much higher in deaths compared with the mean Acute Physiology and Chronic Health Evaluation II score of 10.87 ± 4.40 in survivors (p < 0.001). Acute Physiology and Chronic Health Evaluation II score was independently associated with hospital mortality (adjusted hazard ratio, 1.07; 95% CI, 1.01-1.13). In predicting hospital mortality, Acute Physiology and Chronic Health Evaluation II score demonstrated better discriminative ability (area under the curve, 0.966; 95% CI, 0.942-0.990) than Sequential Organ Failure Assessment score (area under the curve, 0.867; 95% CI, 0.808-0.926) and CURB65 score (area under the curve, 0.844; 95% CI, 0.784-0.905). Based on the cut-off value of 17, Acute Physiology and Chronic Health Evaluation II score could predict the death of patients with coronavirus disease 2019 with a sensitivity of 96.15% and a specificity of 86.27%. Kaplan-Meier analysis showed that the survivor probability of patients with coronavirus disease 2019 with Acute Physiology and Chronic Health Evaluation II score less than 17 was notably higher than that of patients with Acute Physiology and Chronic Health Evaluation II score greater than or equal to 17 (p < 0.001).
Acute Physiology and Chronic Health Evaluation II score was an effective clinical tool to predict hospital mortality in patients with coronavirus disease 2019 compared with Sequential Organ Failure Assessment score and CURB65 score. Acute Physiology and Chronic Health Evaluation II score greater than or equal to 17 serves as an early warning indicator of death and may provide guidance to make further clinical decisions.
新型冠状病毒病（COVID-19）已成为全球主要的健康威胁之一，在中国造成了大量死亡。本研究旨在评估急性生理学与慢性健康评估 II 评分与 COVID-19 患者住院死亡率之间的关系，并比较急性生理学与慢性健康评估 II 评分、序贯器官衰竭评估评分和 confusion, urea, respiratory rate, blood pressure, age 65 (CURB65) 评分的预测能力。
回顾性观察性队列研究。
中国武汉同济医院。
2020 年 1 月 10 日至 2 月 10 日期间因 COVID-19 症状入住同济医院 ICU 的确诊患者。
无。
在 178 例有 COVID-19 症状的潜在合格患者中，23 例（12.92%）被诊断为疑似病例，1 例（0.56%）患者入院后立即发生心脏骤停。最终，154 例患者被纳入分析，其中 52 例（33.77%）死亡。死亡患者的平均急性生理学与慢性健康评估 II 评分（23.23±6.05）明显高于存活患者的平均急性生理学与慢性健康评估 II 评分（10.87±4.40）（p<0.001）。急性生理学与慢性健康评估 II 评分与住院死亡率独立相关（校正后的危险比，1.07；95%置信区间，1.01-1.13）。在预测住院死亡率方面，急性生理学与慢性健康评估 II 评分的区分能力（曲线下面积，0.966；95%置信区间，0.942-0.990）优于序贯器官衰竭评估评分（曲线下面积，0.867；95%置信区间，0.808-0.926）和 CURB65 评分（曲线下面积，0.844；95%置信区间，0.784-0.905）。基于截断值 17，急性生理学与慢性健康评估 II 评分可以预测 COVID-19 患者的死亡，其敏感性为 96.15%，特异性为 86.27%。Kaplan-Meier 分析表明，急性生理学与慢性健康评估 II 评分<17 的 COVID-19 患者的存活概率明显高于急性生理学与慢性健康评估 II 评分≥17 的患者（p<0.001）。
与序贯器官衰竭评估评分和 CURB65 评分相比，急性生理学与慢性健康评估 II 评分是预测 COVID-19 患者住院死亡率的有效临床工具。急性生理学与慢性健康评估 II 评分≥17 是死亡的早期预警指标，并可能为进一步的临床决策提供指导。
