Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Sichuan, PR China; China International Emergency Medical Team, Sichuan, PR China.
China International Emergency Medical Team, Sichuan, PR China; Department of Critical Care Medicine, West China Hospital, Sichuan University, PR China; COVID19 Medical Team (Hubei) of West China Hospital, Sichuan University, PR China; COVID-19 Ward of Renmin Hospital of Wuhan University, PR China.
Am J Emerg Med. 2020 Oct;38(10):2074-2080. doi: 10.1016/j.ajem.2020.07.019. Epub 2020 Jul 12.
The assessment of illness severity at admission can contribute to decreased mortality in patients with the coronavirus disease (COVID-19). This study was conducted to evaluate the effectiveness of the Sequential Organ Failure Assessment (SOFA) and Quick Sequential Organ Failure Assessment (qSOFA) scoring systems at admission for the prediction of mortality risk in COVID-19 patients.
We included 140 critically ill COVID-19 patients. Data on demographics, clinical characteristics, and laboratory findings at admission were used to calculate SOFA and qSOFA against the in-hospital outcomes (survival or death) that were ascertained from the medical records. The predictive accuracy of both scoring systems was evaluated by the receiver operating characteristic (ROC) curve analysis.
The area under the ROC curve for SOFA in predicting mortality was 0.890 (95% CI: 0.826-0.955), which was higher than that of qSOFA (0.742, 95% CI 0.657-0.816). An optimal cutoff of ≥3 for SOFA had sensitivity, specificity, positive predictive value, and negative predictive value of 90.00%, 83.18%, 50.00%, and 97.80%, respectively.
This novel report indicates that SOFA could function as an effective adjunctive risk-stratification tool at admission for critical COVID-19 patients. The performance of qSOFA is accepted but inferior to that of SOFA.
在新型冠状病毒病(COVID-19)患者入院时评估疾病严重程度有助于降低死亡率。本研究旨在评估序贯器官衰竭评估(SOFA)和快速序贯器官衰竭评估(qSOFA)评分系统在入院时对 COVID-19 患者死亡风险预测的有效性。
我们纳入了 140 例危重症 COVID-19 患者。使用入院时的人口统计学、临床特征和实验室检查数据,根据住院结局(生存或死亡)计算 SOFA 和 qSOFA,住院结局从病历中确定。通过接受者操作特征(ROC)曲线分析评估两种评分系统的预测准确性。
SOFA 预测死亡率的 ROC 曲线下面积为 0.890(95%CI:0.826-0.955),高于 qSOFA(0.742,95%CI:0.657-0.816)。SOFA 的最佳截断值≥3 时,其灵敏度、特异性、阳性预测值和阴性预测值分别为 90.00%、83.18%、50.00%和 97.80%。
本研究表明,SOFA 可作为危重新冠肺炎患者入院时的一种有效辅助风险分层工具。qSOFA 的性能得到认可,但逊于 SOFA。