Ali Rashid, Qayyum Fatima, Ahmed Nasir, Haroon Muhammad Zeeshan, Irshad Romana, Sajjad Sabeen, Malik Sidra Qayyum, Saleem Sania, Hussain Rizwana, Zahid Ayesha, Farooq Umer
Department of Medicine, Ayub Teaching Hospital, Abbottabad.
Department of Community Medicine,Ayub Medical College, Abbottabad, Pakistan.
J Ayub Med Coll Abbottabad. 2021 Jan-Mar;33(1):20-25.
Many factors have been identified which can predict severe outcomes and mortality in hospitalized patients of COVID-19. This study was conducted with the objective of finding out the association of various clinical and laboratory parameters as used by International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO)- ISARIC/WHO 4C Mortality score in predicting high risk patients of COVID-19. Ascertaining the parameters would help in triage of patients of severe disease at the outset, and shall prove beneficial in improving the standard of care.
This cross-sectional study was carried out in COVID-19 Department of Ayub Teaching Hospital, Abbottabad. All COVID-19 patients admitted from 15th April to 15th July 2020 were included.
A total of 347 patients were included in the study. The mean age was 56.46±15.44 years. Male patients were 225 (65%) and female 122 (35%). Diabetes (36%) was the most common co-morbidity, followed by hypertension (30.8%). Two hundred & six (63.8%) patients recovered and 117 (36.2%) patients died. Shortness of breath (80%), fever (79%) and cough (65%) were the most common presenting symptoms. Patients admitted with a 4C Mortality score of 0-3 (Low Risk Category), the patients who recovered were 36 (90%) and those who died were 4 (10.0%). In patients admitted with a 4C Mortality score of more than 14 (Very High-Risk Category), the number of patients who recovered was 1 (20%), and those who died were 4 (80%). The difference in mortality among the categories was statistically significant (p<0.001). Hypertension was a risk factor for death in patients of COVID-19 (Odds ratio=1.24, 95% CI [0.76-2.01]). Lymphopenia was not associated with statistically significant increased risk for mortality.
The ISARIC 4C mortality score can be used for stratifying and predicting mortality in COVID-19 patients on arrival in hospital. We propose that it should be used in every patient of COVID-19 presenting to the hospital. Those falling in Low and Intermediate Risk Category should be managed in ward level. Those falling in High and Very High Category should be admitted in HDU/ICU with aggressive treatment from the start.
已确定许多因素可预测新冠肺炎住院患者的严重后果和死亡率。本研究旨在找出国际严重急性呼吸和新发感染联盟（ISARIC）世界卫生组织（WHO）-ISARIC/WHO 4C死亡率评分所使用的各种临床和实验室参数与预测新冠肺炎高危患者之间的关联。确定这些参数将有助于在一开始就对重症患者进行分诊，并将证明有助于提高护理标准。
本横断面研究在阿伯塔巴德阿尤布教学医院的新冠肺炎科进行。纳入了2020年4月15日至7月15日收治的所有新冠肺炎患者。
本研究共纳入347例患者。平均年龄为56.46±15.44岁。男性患者225例（65%），女性122例（35%）。糖尿病（36%）是最常见的合并症，其次是高血压（30.8%）。206例（63.8%）患者康复，117例（36.2%）患者死亡。呼吸急促（80%）、发热（79%）和咳嗽（65%）是最常见的首发症状。4C死亡率评分为0-3（低风险类别）的入院患者中，康复的患者有36例（90%），死亡的患者有4例（10.0%）。4C死亡率评分超过14（极高风险类别）的入院患者中，康复的患者有1例（20%），死亡的患者有4例（80%）。各类别之间的死亡率差异具有统计学意义（p<0.001）。高血压是新冠肺炎患者死亡的危险因素（比值比=1.24，95%可信区间[0.76-2.01]）。淋巴细胞减少与死亡率的统计学显著增加风险无关。
ISARIC 4C死亡率评分可用于对新冠肺炎患者入院时的死亡率进行分层和预测。我们建议对每一位到医院就诊的新冠肺炎患者都使用该评分。低风险和中风险类别的患者应在病房层面进行管理。高风险和极高风险类别的患者应从一开始就入住重症监护病房/重症监护室并接受积极治疗。
