预测疑似 COVID-19 患者在急诊科的不良结局（COVERED）-预测模型的开发、内部和外部验证。

Predicting poor outcome in patients with suspected COVID-19 presenting to the Emergency Department (COVERED) - Development, internal and external validation of a prediction model.

机构信息

Section Emergency Medicine, Emergency Department, Amsterdam Public Health Research Institute.

Section General & Acute Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute.

出版信息

Acute Med. 2021;20(1):4-14.

PMID:33749689

Abstract

BACKGROUND

A recent systematic review recommends against the use of any of the current COVID-19 prediction models in clinical practice. To enable clinicians to appropriately profile and treat suspected COVID-19 patients at the emergency department (ED), externally validated models that predict poor outcome are desperately needed.

OBJECTIVE

Our aims were to identify predictors of poor outcome, defined as mortality or ICU admission within 30 days, in patients presenting to the ED with a clinical suspicion of COVID-19, and to develop and externally validate a prediction model for poor outcome.

METHODS

In this prospective, multi-center study, we enrolled suspected COVID-19 patients presenting at the EDs of two hospitals in the Netherlands. We used backward logistic regression to develop a prediction model. We used the area under the curve (AUC), Brier score and pseudo-R2 to assess model performance. The model was externally validated in an Italian cohort.

RESULTS

We included 1193 patients between March 12 and May 27 2020, of whom 196 (16.4%) had a poor outcome. We identified 10 predictors of poor outcome: current malignancy (OR 2.774; 95%CI 1.682-4.576), systolic blood pressure (OR 0.981; 95%CI 0.964-0.998), heart rate (OR 1.001; 95%CI 0.97-1.028), respiratory rate (OR 1.078; 95%CI 1.046-1.111), oxygen saturation (OR 0.899; 95%CI 0.850-0.952), body temperature (OR 0.505; 95%CI 0.359-0.710), serum urea (OR 1.404; 95%CI 1.198-1.645), C-reactive protein (OR 1.013; 95%CI 1.001-1.024), lactate dehydrogenase (OR 1.007; 95%CI 1.002-1.013) and SARS-CoV-2 PCR result (OR 2.456; 95%CI 1.526-3.953). The AUC was 0.86 (95%CI 0.83-0.89), with a Brier score of 0.32 and, and R2 of 0.41. The AUC in the external validation in 500 patients was 0.70 (95%CI 0.65-0.75).

CONCLUSION

The COVERED risk score showed excellent discriminatory ability, also in an external validation. It may aid clinical decision making, and improve triage at the ED in health care environments with high patient throughputs.

摘要

背景

最近的一项系统评价建议不要在临床实践中使用目前任何一种 COVID-19 预测模型。为了使临床医生能够在急诊科对疑似 COVID-19 的患者进行适当的评估和治疗，迫切需要能够预测不良结局的外部验证模型。

目的

我们旨在确定在因临床疑似 COVID-19 而就诊于急诊科的患者中，预测不良结局（定义为 30 天内死亡或入住 ICU）的预测因素，并开发和外部验证预测不良结局的模型。

方法

在这项前瞻性、多中心研究中，我们纳入了荷兰两家医院急诊科疑似 COVID-19 的患者。我们使用向后逻辑回归来开发预测模型。我们使用曲线下面积（AUC）、Brier 评分和伪 R2 来评估模型性能。该模型在意大利队列中进行了外部验证。

结果

我们于 2020 年 3 月 12 日至 5 月 27 日期间纳入了 1193 例患者，其中 196 例（16.4%）存在不良结局。我们确定了 10 个不良结局的预测因素：当前恶性肿瘤（OR 2.774；95%CI 1.682-4.576）、收缩压（OR 0.981；95%CI 0.964-0.998）、心率（OR 1.001；95%CI 0.97-1.028）、呼吸频率（OR 1.078；95%CI 1.046-1.111）、血氧饱和度（OR 0.899；95%CI 0.850-0.952）、体温（OR 0.505；95%CI 0.359-0.710）、血清尿素（OR 1.404；95%CI 1.198-1.645）、C 反应蛋白（OR 1.013；95%CI 1.001-1.024）、乳酸脱氢酶（OR 1.007；95%CI 1.002-1.013）和 SARS-CoV-2 PCR 结果（OR 2.456；95%CI 1.526-3.953）。AUC 为 0.86（95%CI 0.83-0.89），Brier 得分为 0.32，R2 为 0.41。在 500 例外部验证患者中，AUC 为 0.70（95%CI 0.65-0.75）。