Holten Aleksander Rygh, Nore Kristin Grotle, Tveiten Caroline Emilie Van Woensel Kooy, Olasveengen Theresa Mariero, Tonby Kristian
Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Resusc Plus. 2020 Dec;4:100042. doi: 10.1016/j.resplu.2020.100042. Epub 2020 Oct 21.
COVID-19 may lead to severe disease, requiring intensive care treatment and challenging the capacity of health care systems. The aim of this study was to compare the ability of commonly used scoring systems for sepsis and pneumonia to predict severe COVID-19 in the emergency department.
Prospective, observational, single centre study in a secondary/tertiary care hospital in Oslo, Norway. Patients were assessed upon hospital admission using the following scoring systems; quick Sequential Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome criteria (SIRS), National Early Warning Score 2 (NEWS2), CURB-65 and Pneumonia Severity index (PSI). The ratio of arterial oxygen tension to inspiratory oxygen fraction (P/F-ratio) was also calculated. The area under the receiver operating characteristics curve (AUROC) for each scoring system was calculated, along with sensitivity and specificity for the most commonly used cut-offs. Severe disease was defined as death or treatment in ICU within 14 days.
38 of 175 study participants developed severe disease, 13 (7%) died and 29 (17%) had a stay at an intensive care unit (ICU). NEWS2 displayed an AUROC of 0.80 (95% confidence interval 0.72-0.88), CURB-65 0.75 (0.65-0.84), PSI 0.75 (0.65-0.84), SIRS 0.70 (0.61-0.80) and qSOFA 0.70 (0.61-0.79). NEWS2 was significantly better than SIRS and qSOFA in predicating severe disease, and with a cut-off of5 points, had a sensitivity and specificity of 82% and 60%, respectively.
NEWS2 predicted severe COVID-19 disease more accurately than SIRS and qSOFA, but not significantly better than CURB65 and PSI. NEWS2 may be a useful screening tool in evaluating COVID-19 patients during hospital admission.
: ClinicalTrials.gov Identifier: NCT04345536. (https://clinicaltrials.gov/ct2/show/NCT04345536).
新型冠状病毒肺炎（COVID-19）可能导致严重疾病，需要重症监护治疗，这对医疗系统的能力构成了挑战。本研究的目的是比较常用的脓毒症和肺炎评分系统在急诊科预测重症COVID-19的能力。
在挪威奥斯陆的一家二级/三级护理医院进行前瞻性、观察性、单中心研究。患者入院时使用以下评分系统进行评估：快速序贯器官衰竭评估（qSOFA）、全身炎症反应综合征标准（SIRS）、国家早期预警评分2（NEWS2）、CURB-65和肺炎严重程度指数（PSI）。还计算了动脉血氧分压与吸入氧分数之比（P/F比）。计算每个评分系统的受试者操作特征曲线下面积（AUROC），以及最常用临界值的敏感性和特异性。严重疾病定义为14天内死亡或入住重症监护病房治疗。
175名研究参与者中有38人发展为严重疾病，13人（7%）死亡，29人（17%）入住重症监护病房（ICU）。NEWS2的AUROC为0.80（95%置信区间0.72-0.88），CURB-65为0.75（0.65-0.84），PSI为0.75（0.65-0.84），SIRS为0.70（0.61-0.80），qSOFA为0.70（0.61-0.79）。在预测严重疾病方面，NEWS2明显优于SIRS和qSOFA，临界值为5分时，敏感性和特异性分别为82%和60%。
NEWS2预测重症COVID-19疾病比SIRS和qSOFA更准确，但不比CURB65和PSI显著更好。NEWS2可能是评估COVID-19患者入院时的有用筛查工具。
ClinicalTrials.gov标识符：NCT04345536。（https://clinicaltrials.gov/ct2/show/NCT04345536）
