因临床恶化而入住急诊科的 COVID-19 患者中改良 CHA2DS2-VASc 评分的预后准确性。
Prognostic Accuracy of the Modified CHA2DS2-VASc Score in COVID-19 Patients Admitted to the Emergency Department Due to Clinical Worsening.
机构信息
Cardiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Centro Académico de Medicina de Lisboa. Centro Cardiovascular da Universidade de Lisboa. Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal.
Cardiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Centro Académico de Medicina de Lisboa. Centro Cardiovascular da Universidade de Lisboa. Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal.
出版信息
Acta Med Port. 2022 Jun 1;35(6):433-442. doi: 10.20344/amp.17016. Epub 2021 Nov 26.
INTRODUCTION
Risk factors comprising the CHA2DS2VASc score are recognized as risk factors for venous thromboembolism and mortality in COVID-19 patients. A modified CHA2DS2VASc score (M-CHA2D2VASc), developed by changing gender criteria from female to male, has been proposed to predict in-hospital mortality in COVID-19 patients. The aim of this study was to evaluate the prognostic accuracy of M-CHA2D2VASc for adverse clinical outcomes and short-term mortality in COVID-19 patients admitted to the Emergency Department.
MATERIAL AND METHODS
Retrospective study of patients admitted to the ED who underwent computed tomography pulmonary angiography due to suspected pulmonary embolism or clinical worsening. Patients were stratified into three M-CHA2DS2-VASc risk-categories: low (0 - 1 points), intermediate (2 - 3 points) and high-risk (≥ 4 points).
RESULTS
We included 300 patients (median age 71 years, 59% male). The overall mortality was 27%. The M-CHA2DS2-VASc score was higher in non-survivors compared to survivors [4 (IQR:3 - 5) vs 2 (IQR: 1 - 4), respectively, p < 0.001). The M-CHA2DS2-VASc score was identified as an independent predictor of mortality in a multivariable logistic regression model (OR 1.406, p = 0.007). The Kaplan-Meier survival curves showed that the M-CHA2DS2-VASc score was associated with short-term mortality (log-rank test < 0.001), regardless of hospitalization (log-rank test p < 0.001 and p = 0.007, respectively). The survival proportion was 92%, 80% and 63% in the lower, intermediate, and higher risk-groups. As for the risk-categories, no difference was found in pulmonary embolism, Intensive Care Unit admission, and invasive mechanical ventilation.
DISCUSSION
This is the first study to validate M-CHA2DS2-VASc score as a predictor of short-term mortality in patients admitted to the Emergency Department.
CONCLUSION
The M-CHA2DS2-VASC score might be useful for prompt risk-stratification in COVID-19 patients during admission to the Emergency Department.
简介
CHA2DS2VASc 评分中的风险因素被认为是 COVID-19 患者静脉血栓栓塞和死亡的风险因素。一种改良的 CHA2DS2VASc 评分（M-CHA2D2VASc），通过将性别标准从女性改为男性来预测 COVID-19 患者的住院死亡率。本研究旨在评估 M-CHA2D2VASc 对急诊就诊 COVID-19 患者不良临床结局和短期死亡率的预后准确性。
材料和方法
回顾性研究因疑似肺栓塞或临床恶化而接受计算机断层肺动脉造影的急诊科入院患者。患者被分为三个 M-CHA2DS2-VASc 风险类别：低（0-1 分）、中（2-3 分）和高风险（≥4 分）。
结果
我们纳入了 300 名患者（中位年龄 71 岁，59%为男性）。总死亡率为 27%。与幸存者相比，非幸存者的 M-CHA2DS2-VASc 评分更高[分别为 4（IQR：3-5）与 2（IQR：1-4），p<0.001]。多变量逻辑回归模型显示，M-CHA2DS2-VASc 评分是死亡率的独立预测因素（OR 1.406，p=0.007）。Kaplan-Meier 生存曲线显示，M-CHA2DS2-VASc 评分与短期死亡率相关（对数秩检验<0.001），与住院无关（对数秩检验 p<0.001 和 p=0.007）。低、中、高风险组的生存比例分别为 92%、80%和 63%。至于风险类别，在肺栓塞、入住重症监护病房和有创机械通气方面没有差异。
讨论
这是第一项验证 M-CHA2DS2-VASc 评分作为急诊科入院患者短期死亡率预测指标的研究。
结论
M-CHA2DS2-VASC 评分可能有助于在 COVID-19 患者入住急诊科时进行快速风险分层。
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