VieCuri Medical Center, Department of Emergency Medicine, Venlo, the Netherlands.
VieCuri Medical Center, Department of Emergency Medicine, Venlo, the Netherlands; VieCuri Medical Center, Intensive Care Unit, Venlo, the Netherlands.
Am J Emerg Med. 2021 Nov;49:76-79. doi: 10.1016/j.ajem.2021.05.049. Epub 2021 May 21.
The COVID-19 outbreak has put an unprecedented strain on Emergency Departments (EDs) and other critical care resources. Early detection of patients that are at high risk of clinical deterioration and require intensive monitoring, is key in ED evaluation and disposition. A rapid and easy risk-stratification tool could aid clinicians in early decision making. The Shock Index (SI: heart rate/systolic blood pressure) proved useful in detecting hemodynamic instability in sepsis and myocardial infarction patients. In this study we aim to determine whether SI is discriminative for ICU admission and in-hospital mortality in COVID-19 patients.
Retrospective, observational, single-center study. All patients ≥18 years old who were hospitalized with COVID-19 (defined as: positive result on reverse transcription polymerase chain reaction (PCR) test) between March 1, 2020 and December 31, 2020 were included for analysis. Data were collected from electronic medical patient records and stored in a protected database. ED shock index was calculated and analyzed for its discriminative value on in-hospital mortality and ICU admission by a ROC curve analysis.
In total, 411 patients were included. Of all patients 249 (61%) were male. ICU admission was observed in 92 patients (22%). Of these, 37 patients (40%) died in the ICU. Total in-hospital mortality was 28% (114 patients). For in-hospital mortality the optimal cut-off SI ≥ 0.86 was not discriminative (AUC 0.49 (95% CI: 0.43-0.56)), with a sensitivity of 12.3% and specificity of 93.6%. For ICU admission the optimal cut-off SI ≥ 0.57 was also not discriminative (AUC 0.56 (95% CI: 0.49-0.62)), with a sensitivity of 78.3% and a specificity of 34.2%.
In this cohort of patients hospitalized with COVID-19, SI measured at ED presentation was not discriminative for ICU admission and was not useful for early identification of patients at risk of clinical deterioration.
COVID-19 疫情给急诊科（ED）和其他重症监护资源带来了前所未有的压力。早期发现有临床恶化风险并需要加强监测的高危患者是 ED 评估和处置的关键。快速简便的风险分层工具可以帮助临床医生做出早期决策。休克指数（SI：心率/收缩压）已被证明可用于检测败血症和心肌梗死患者的血流动力学不稳定。在这项研究中，我们旨在确定 SI 是否可用于区分 COVID-19 患者的 ICU 入院和院内死亡率。
回顾性、观察性、单中心研究。所有 2020 年 3 月 1 日至 2020 年 12 月 31 日期间因 COVID-19 住院的年龄≥18 岁的患者（定义为逆转录聚合酶链反应（PCR）检测阳性结果）均纳入分析。数据从电子病历中收集并存储在受保护的数据库中。通过 ROC 曲线分析计算和分析 ED 休克指数对院内死亡率和 ICU 入院的鉴别价值。
共纳入 411 例患者。所有患者中，249 例（61%）为男性。92 例（22%）患者入住 ICU。其中，37 例（40%）患者在 ICU 死亡。总院内死亡率为 28%（114 例）。对于院内死亡率，最佳 SI≥0.86 截断值无鉴别能力（AUC 0.49（95%CI：0.43-0.56）），敏感性为 12.3%，特异性为 93.6%。对于 ICU 入院，最佳 SI≥0.57 截断值也无鉴别能力（AUC 0.56（95%CI：0.49-0.62）），敏感性为 78.3%，特异性为 34.2%。
在本队列中，COVID-19 住院患者的 ED 就诊时的 SI 无鉴别能力，不能用于早期识别有临床恶化风险的患者。
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