Suresh Soorya, Tiwari Atul, Mathew Roshan, Bhaskararayuni Jyothiswaroop, Sahu Ankit Kumar, Aggarwal Praveen, Murmu L R, Bhoi Sanjeev, Nayer Jamshed, Ekka Meera, Kumar Akshay, Mishra Prakash, Sinha Tej Prakash
Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
J Family Med Prim Care. 2021 Jan;10(1):542-549. doi: 10.4103/jfmpc.jfmpc_1775_20. Epub 2021 Jan 30.
As the number of COVID-19 cases keeps on rising, a better awareness of the nature and severity of the disease will aid in clinical decision-making and management. Hence, this study was conducted to find the predictors of mortality and the need for mechanical ventilation in COVID-19 patients.
This was a single centre, prospective observational study conducted in a tertiary care centre in north India. We included patients with influenza like illness who tested positive for COVID-19. Information regarding patient demography, symptoms, and vital signs on presentation, laboratory values, chest imaging findings, and disease severity was collected by the emergency physician. QSOFA score and National early warning score (NEWS) score were calculated using initial vital signs. Each patient was followed up till discharge or death.
We included 116 COVID-19 patients with 33 patients having mild, 46 patients with severe and 37 patients with critical disease. The median age of our patients was 47 years (39-59) with 63% males. About 58% of patients had at least one comorbidity and shortness of breath was the most common presenting feature. The patients with severe and critical disease had a significantly higher respiratory rate and heart rate as compared to mild disease ( < 0.05). SpO2 of those with critical disease was significantly lower as compared to those with mild disease. Mechanical ventilation was required in around 36% of patients which included 67% of patients with critical disease. The overall mortality was 51% with 90% among critical disease. Lower SpO2 and GCS were the only parameters that showed a significant association with mortality and need for mechanical ventilation. The receiver operating characteristics analysis showed NEWS score as a better predictor of mortality and need for mechanical ventilation as compared to qSOFA score.
NEWS and qSOFA scores are useful tools in predicting fatal outcomes in COVID patients with NEWS score being a better score than qSOFA.
随着新冠病毒病（COVID-19）病例数持续上升，更好地了解该疾病的性质和严重程度将有助于临床决策和管理。因此，本研究旨在寻找COVID-19患者死亡及需要机械通气的预测因素。
这是一项在印度北部一家三级医疗中心进行的单中心前瞻性观察性研究。我们纳入了COVID-19检测呈阳性的流感样疾病患者。急诊医生收集了患者的人口统计学信息、症状、就诊时的生命体征、实验室检查值、胸部影像学检查结果及疾病严重程度。使用初始生命体征计算快速序贯器官衰竭评估（QSOFA）评分和国家早期预警评分（NEWS）。对每位患者进行随访直至出院或死亡。
我们纳入了116例COVID-19患者，其中33例为轻症，46例为重症，37例为危重症。患者的中位年龄为47岁（39 - 59岁），男性占63%。约58%的患者至少有一种合并症，呼吸急促是最常见的症状。与轻症患者相比，重症和危重症患者的呼吸频率和心率显著更高（P < 0.05）。危重症患者的血氧饱和度（SpO2）显著低于轻症患者。约36%的患者需要机械通气，其中危重症患者占67%。总体死亡率为51%，危重症患者死亡率为90%。较低的SpO2和格拉斯哥昏迷量表（GCS）评分是仅有的与死亡及需要机械通气显著相关的参数。受试者工作特征分析显示，与QSOFA评分相比，NEWS评分是死亡及需要机械通气的更好预测指标。
NEWS和QSOFA评分是预测COVID患者不良结局的有用工具，其中NEWS评分优于QSOFA评分。
