Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil.
Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil.
Age Ageing. 2021 Jan 8;50(1):32-39. doi: 10.1093/ageing/afaa240.
Although coronavirus disease 2019 (COVID-19) disproportionally affects older adults, the use of conventional triage tools in acute care settings ignores the key aspects of vulnerability.
This study aimed to determine the usefulness of adding a rapid vulnerability screening to an illness acuity tool to predict mortality in hospitalised COVID-19 patients.
Cohort study.
Large university hospital dedicated to providing COVID-19 care.
Participants included are 1,428 consecutive inpatients aged ≥50 years.
Vulnerability was assessed using the modified version of PRO-AGE score (0-7; higher = worse), a validated and easy-to-administer tool that rates physical impairment, recent hospitalisation, acute mental change, weight loss and fatigue. The baseline covariates included age, sex, Charlson comorbidity score and the National Early Warning Score (NEWS), a well-known illness acuity tool. Our outcome was time-to-death within 60 days of admission.
The patients had a median age of 66 years, and 58% were male. The incidence of 60-day mortality ranged from 22% to 69% across the quartiles of modified PRO-AGE. In adjusted analysis, compared with modified PRO-AGE scores 0-1 ('lowest quartile'), the hazard ratios (95% confidence interval) for 60-day mortality for modified PRO-AGE scores 2-3, 4 and 5-7 were 1.4 (1.1-1.9), 2.0 (1.5-2.7) and 2.8 (2.1-3.8), respectively. The modified PRO-AGE predicted different mortality risk levels within each stratum of NEWS and improved the discrimination of mortality prediction models.
Adding vulnerability to illness acuity improved accuracy of predicting mortality in hospitalised COVID-19 patients. Combining tools such as PRO-AGE and NEWS may help stratify the risk of mortality from COVID-19.
虽然 2019 年冠状病毒病（COVID-19）不成比例地影响老年人，但在急性护理环境中使用常规分诊工具忽略了脆弱性的关键方面。
本研究旨在确定在住院 COVID-19 患者中，使用快速脆弱性筛查来预测死亡率的发病率工具的有用性。
队列研究。
大型大学医院，专门提供 COVID-19 护理。
纳入的参与者是连续 1428 名年龄≥50 岁的住院患者。
使用改良版 PRO-AGE 评分（0-7；得分越高表示越差）评估脆弱性，这是一种经过验证且易于管理的工具，可评估身体损伤、近期住院、急性精神变化、体重减轻和疲劳。基线协变量包括年龄、性别、Charlson 合并症评分和国家早期预警评分（NEWS），这是一种众所周知的发病率工具。我们的结果是入院后 60 天内的死亡时间。
患者的中位年龄为 66 岁，58%为男性。改良 PRO-AGE 四分位数的 60 天死亡率范围为 22%至 69%。在调整分析中，与改良 PRO-AGE 评分 0-1（“最低四分位数”）相比，改良 PRO-AGE 评分 2-3、4 和 5-7 的 60 天死亡率的风险比（95%置信区间）分别为 1.4（1.1-1.9）、2.0（1.5-2.7）和 2.8（2.1-3.8）。改良 PRO-AGE 在 NEWS 的每个分层内预测了不同的死亡率风险水平，并提高了死亡率预测模型的区分度。
将脆弱性纳入发病率可提高住院 COVID-19 患者死亡率预测的准确性。结合 PRO-AGE 和 NEWS 等工具可以帮助分层 COVID-19 死亡率风险。
