运动后血氧饱和度作为疑似 COVID-19 急诊患者不良结局的预后因素：PRIEST 观察性队列研究的亚研究。
Post-exertion oxygen saturation as a prognostic factor for adverse outcome in patients attending the emergency department with suspected COVID-19: a substudy of the PRIEST observational cohort study.
机构信息
School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
出版信息
Emerg Med J. 2021 Feb;38(2):88-93. doi: 10.1136/emermed-2020-210528. Epub 2020 Dec 3.
BACKGROUND
Measurement of post-exertion oxygen saturation has been proposed to assess illness severity in suspected COVID-19 infection. We aimed to determine the accuracy of post-exertional oxygen saturation for predicting adverse outcome in suspected COVID-19.
METHODS
We undertook a substudy of an observational cohort study across 70 emergency departments during the first wave of the COVID-19 pandemic in the UK. We collected data prospectively, using a standardised assessment form, and retrospectively, using hospital records, from patients with suspected COVID-19, and reviewed hospital records at 30 days for adverse outcome (death or receiving organ support). Patients with post-exertion oxygen saturation recorded were selected for this analysis. We constructed receiver-operating characteristic curves, calculated diagnostic parameters, and developed a multivariable model for predicting adverse outcome.
RESULTS
We analysed data from 817 patients with post-exertion oxygen saturation recorded after excluding 54 in whom measurement appeared unfeasible. The c-statistic for post-exertion change in oxygen saturation was 0.589 (95% CI 0.465 to 0.713), and the positive and negative likelihood ratios of a 3% or more desaturation were, respectively, 1.78 (1.25 to 2.53) and 0.67 (0.46 to 0.98). Multivariable analysis showed that post-exertion oxygen saturation was not a significant predictor of adverse outcome when baseline clinical assessment was taken into account (p=0.368). Secondary analysis excluding patients in whom post-exertion measurement appeared inappropriate resulted in a c-statistic of 0.699 (0.581 to 0.817), likelihood ratios of 1.98 (1.26 to 3.10) and 0.61 (0.35 to 1.07), and some evidence of additional prognostic value on multivariable analysis (p=0.019).
CONCLUSIONS
Post-exertion oxygen saturation provides modest prognostic information in the assessment of selected patients attending the emergency department with suspected COVID-19.
TRIAL REGISTRATION NUMBER
ISRCTN Registry (ISRCTN56149622) http://www.isrctn.com/ISRCTN28342533.
背景
运动后血氧饱和度的测量被提议用于评估疑似 COVID-19 感染的疾病严重程度。我们旨在确定运动后血氧饱和度对预测疑似 COVID-19 不良结局的准确性。
方法
我们在英国 COVID-19 大流行的第一波期间在 70 个急诊科进行了一项观察性队列研究的子研究。我们使用标准化评估表前瞻性地收集数据，并使用医院记录回顾性地收集数据，从疑似 COVID-19 患者中收集数据，并在 30 天内查看医院记录以确定不良结局（死亡或接受器官支持）。选择记录了运动后血氧饱和度的患者进行这项分析。我们构建了受试者工作特征曲线，计算了诊断参数，并为预测不良结局开发了一个多变量模型。
结果
我们分析了排除 54 名因测量似乎不可行而排除的患者后记录了运动后血氧饱和度的 817 名患者的数据。运动后血氧饱和度变化的 c 统计量为 0.589（95%CI 0.465 至 0.713），血氧饱和度下降 3%或更多的阳性和阴性似然比分别为 1.78（1.25 至 2.53）和 0.67（0.46 至 0.98）。多变量分析表明，考虑到基线临床评估，运动后血氧饱和度不是不良结局的显著预测因素（p=0.368）。排除运动后测量似乎不合适的患者的二次分析导致 c 统计量为 0.699（0.581 至 0.817），似然比为 1.98（1.26 至 3.10）和 0.61（0.35 至 1.07），以及多变量分析中有一些额外预后价值的证据（p=0.019）。
结论
在评估因疑似 COVID-19 而就诊急诊科的选定患者时，运动后血氧饱和度提供了适度的预后信息。
试验注册号
ISRCTN Registry（ISRCTN56149622）http://www.isrctn.com/ISRCTN28342533。
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