Internal Medicine Department, The American British Cowdray Medical Center, Mexico City, Mexico.
Research Unit in Endocrine Diseases, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
PLoS One. 2021 Apr 5;16(4):e0248357. doi: 10.1371/journal.pone.0248357. eCollection 2021.
Coronavirus disease 2019 (COVID-19) is a systemic disease that can rapidly progress into acute respiratory failure and death. Timely identification of these patients is crucial for a proper administration of health-care resources.
To develop a predictive score that estimates the risk of invasive mechanical ventilation (IMV) among patients with COVID-19.
Retrospective cohort study of 401 COVID-19 patients diagnosed from March 12, to August 10, 2020. The score development cohort comprised 211 patients (52.62% of total sample) whereas the validation cohort included 190 patients (47.38% of total sample). We divided participants according to the need of invasive mechanical ventilation (IMV) and looked for potential predictive variables.
We developed two predictive scores, one based on Interleukin-6 (IL-6) and the other one on the Neutrophil/Lymphocyte ratio (NLR), using the following variables: respiratory rate, SpO2/FiO2 ratio and lactic dehydrogenase (LDH). The area under the curve (AUC) in the development cohort was 0.877 (0.823-0.931) using the NLR based score and 0.891 (0.843-0.939) using the IL-6 based score. When compared with other similar scores developed for the prediction of adverse outcomes in COVID-19, the COVID-IRS scores proved to be superior in the prediction of IMV.
The COVID-IRS scores accurately predict the need for mechanical ventilation in COVID-19 patients using readily available variables taken upon admission. More studies testing the applicability of COVID-IRS in other centers and populations, as well as its performance as a triage tool for COVID-19 patients are needed.
2019 年冠状病毒病（COVID-19）是一种全身性疾病，可迅速发展为急性呼吸衰竭和死亡。及时识别这些患者对于合理分配医疗资源至关重要。
开发一种预测评分，用于估计 COVID-19 患者接受有创机械通气（IMV）的风险。
回顾性队列研究，纳入 2020 年 3 月 12 日至 8 月 10 日期间诊断的 401 例 COVID-19 患者。评分开发队列包括 211 例患者（总样本的 52.62%），验证队列包括 190 例患者（总样本的 47.38%）。我们根据是否需要有创机械通气（IMV）将参与者进行分组，并寻找潜在的预测变量。
我们开发了两种预测评分，一种基于白细胞介素-6（IL-6），另一种基于中性粒细胞/淋巴细胞比值（NLR），使用以下变量：呼吸频率、SpO2/FiO2 比值和乳酸脱氢酶（LDH）。在开发队列中，NLR 评分的曲线下面积（AUC）为 0.877（0.823-0.931），IL-6 评分的 AUC 为 0.891（0.843-0.939）。与其他用于预测 COVID-19 不良结局的类似评分相比，COVID-IRS 评分在预测 IMV 方面表现更优。
COVID-IRS 评分使用入院时即可获得的易于获取的变量，准确预测 COVID-19 患者机械通气的需求。需要更多研究在其他中心和人群中测试 COVID-IRS 的适用性及其作为 COVID-19 患者分诊工具的性能。
