Wang X, Hu Z W, Hu Y, Cheng Y, Zhang H, Li H C, Ma J, Wang G F, Zhao J P
Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China.
Department of Respiratory and Critical Care Medicine, Tongji Hospital, Wuhan 430030, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2020 Oct 12;43(10):834-838. doi: 10.3760/cma.j.cn112147-20200226-00186.
To investigate the application of severity classification according to the protocol on the Diagnosis and Treatment of coronavirus disease 2019(COVID-19)by the National Health Commission of China, pneumonia severity index(PSI) and CURB-65 in risk stratification and prognostic assessment of COVID-19. Clinical data of 234 in-hospital patients with COVID-19 were collected and retrospectively reviewed in Wuhan Tongji Hospital. Patients were divided into 3 groups (common, severe, and critical type) at admission according to the sixth version of the protocol issued by the National Health Commission of China on Diagnosis and Treatment of COVID-19. At the same time, the severity of pneumonia was calculated by PSI and CURB-65, and the patients were stratified into 3 risk groups, namely mild, moderate, and severe groups. The hospital mortality rate was evaluated in each group. Sensitivity, specificity, positive predictive values, negative predictive values, and the area under the receiver operating characteristic(ROC) curve(AUC) for predicting hospital mortality in each rule were assessed. According to the severity classification of Chinese protocol, the proportion of patients with common type, severe type, and the critical type was 15.8%, 75.6%, and 8.5%, respectively. No in-hospital death occurred in the common type. As for PSI and CURB-65, greater proportions of patients were classified as low risk(79.1% and 75.6%, respectively), while smaller proportions of patients were classified as moderate and high risk(16.2%, 15.0%; 4.7%, 9.4%, respectively). In-hospital death occurred in low and moderate risk patients identified by these 2 scoring systems. The mortality of the critical group of the Chinese protocol was 65%, and the sensitivity and specificity of predicting in-hospital mortality were 36.4% and 97.0%, respectively. The mortality in the high risk group of PSI and CURB-65 was 100% and 77.3%. The risk class V of PSI and CURB-65 score 3-5 had high specificity(100% and 97.4%, respectively)but low sensitivity(33.3% and 51.5%, respectively)in predicting in-hospital mortality. The AUC of the Chinese protocol severity classification, PSI, and CURB-65 was 0.735, 0.951, and 0.912. The optimal cut-off point of PSI was risk class Ⅳ, and the sensitivity and specificity for predicting mortality were 90.9% and 90.5%. The optimal cut-off point of CURB-65 was score 2, and the corresponding sensitivity and specificity were 84.8% and 85.6%. PSI and CURB-65 can be used for risk stratification and prognostic assessment in patients with COVID-19.
为探讨中国国家卫生健康委员会《新型冠状病毒肺炎诊疗方案》中严重程度分类方案在新型冠状病毒病(COVID-19)风险分层及预后评估中的应用,以及肺炎严重程度指数(PSI)和CURB-65评分在COVID-19风险分层及预后评估中的应用。收集武汉同济医院234例住院COVID-19患者的临床资料并进行回顾性分析。根据中国国家卫生健康委员会发布的《新型冠状病毒肺炎诊疗方案(第六版)》,患者入院时分为3组(普通型、重型和危重型)。同时,采用PSI和CURB-65计算肺炎严重程度,将患者分为3个风险组,即轻度、中度和重度组。评估每组患者的院内死亡率。评估各规则预测院内死亡的敏感度、特异度、阳性预测值、阴性预测值及受试者工作特征(ROC)曲线下面积(AUC)。按照中国诊疗方案的严重程度分类,普通型、重型和危重型患者的比例分别为15.8%、75.6%和8.5%。普通型患者无院内死亡。对于PSI和CURB-65,更多患者被分类为低风险(分别为79.1%和75.6%),而被分类为中度和高风险的患者比例较小(分别为16.2%、15.0%;4.7%、9.4%)。这两种评分系统识别出的低风险和中度风险患者发生了院内死亡。中国诊疗方案危重组的死亡率为65%,预测院内死亡的敏感度和特异度分别为36.4%和97.0%。PSI和CURB-65高风险组的死亡率分别为100%和77.3%。PSI和CURB-65评分3 - 5分的风险Ⅴ级在预测院内死亡方面具有高特异度(分别为100%和97.4%)但低敏感度(分别为33.3%和51.5%)。中国诊疗方案严重程度分类、PSI和CURB-65的AUC分别为0.735、0.951和0.912。PSI的最佳截断点为风险Ⅳ级,预测死亡率的敏感度和特异度分别为90.9%和90.5%。CURB-65的最佳截断点为2分,相应的敏感度和特异度分别为84.8%和85.6%。PSI和CURB-65可用于COVID-19患者的风险分层及预后评估。