Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Roma, Italy.
Emergency Medicine Unit, Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Roma, Italy.
Int J Clin Pract. 2021 Sep;75(9):e14426. doi: 10.1111/ijcp.14426. Epub 2021 Jun 16.
Patients with coronavirus disease 2019 (COVID-19) are often treated at home given the limited healthcare resources. Many patients may have sudden clinical worsening and may be already compromised at hospitalisation. We investigated the burden of lung involvement according to the time to hospitalisation.
In this observational cohort study, 55 consecutive COVID-19-related pneumonia patients were admitted to the Emergency Medicine Unit. Groups of lung involvement at computed tomography were classified as follows: 0 (<5%), 1 (5%-25%), 2 (26%-50%), 3 (51%-75%) and 4 (>75%). We also investigated in-hospital death and the predictive value of Yan-XGBoost model and PREDI-CO scores for death.
The median age was 74 years and 34 were men. Time to admission increased from 2 days in group 0 to 8.5-9 days in groups 3 and 4. A progressive increase in LDH, CRP and d-dimer was found across groups, while a decrease of lymphocytes paO /FiO ratio and SpO was found. Ten (18.2%) patients died during the in-hospital staying. Patients who died were older, with a trend to lower lymphocytes, a higher d-dimer, creatine phosphokinase and troponin T. The Yan-XGBoost model did not accurately predict in-hospital death with an AUC of 0.57 (95% confidence interval [CI] 0.37-0.76), which improved after the addition of the lung involvement groups (AUC 0.68, 95%CI 0.45-0.90). Conversely, a good predictive value was found for the original PREDI-CO score with an AUC of 0.76 (95% CI 0.58-0.93) which remained similar after the addition of the lung involvement (AUC 0.76, 95% CI 0.57-0.94).
We found that delayed hospital admission is associated with higher lung involvement. Hence, our data suggest that patients at risk for more severe disease, such as those with high LDH, CRP and d-dimer, should be promptly referred to hospital care.
由于医疗资源有限，许多 2019 年冠状病毒病（COVID-19）患者经常在家中接受治疗。许多患者可能会突然出现临床恶化，并且在住院时已经病情恶化。我们根据住院时间调查了肺部受累的负担。
在这项观察性队列研究中，连续收治了 55 名与 COVID-19 相关的肺炎患者到急诊医学科。根据计算机断层扫描（CT）结果将肺部受累的分组如下：0（<5%），1（5%-25%），2（26%-50%），3（51%-75%）和 4（>75%）。我们还调查了住院期间的死亡情况，以及 Yan-XGBoost 模型和 PREDI-CO 评分对死亡的预测价值。
中位年龄为 74 岁，34 名男性。从 0 组的 2 天到 3 组和 4 组的 8.5-9 天，住院时间逐渐延长。随着组别的增加，乳酸脱氢酶（LDH）、C 反应蛋白（CRP）和 D-二聚体逐渐升高，而淋巴细胞 PaO /FiO 比值和 SpO 则逐渐降低。住院期间有 10 例（18.2%）患者死亡。死亡患者年龄较大，淋巴细胞趋势较低，D-二聚体、肌酸磷酸激酶（CPK）和肌钙蛋白 T 较高。Yan-XGBoost 模型对住院死亡的预测准确性不高，AUC 为 0.57（95%置信区间[CI] 0.37-0.76），加入肺部受累组后有所改善（AUC 0.68，95%CI 0.45-0.90）。相反，原始 PREDI-CO 评分具有良好的预测价值，AUC 为 0.76（95%CI 0.58-0.93），加入肺部受累组后相似（AUC 0.76，95%CI 0.57-0.94）。
我们发现延迟住院与更高的肺部受累有关。因此，我们的数据表明，LDH、CRP 和 D-二聚体较高的高危疾病患者应尽快转至医院治疗。
