年龄调整 Charlson 共病指数（ACCI）在外科患者术后 SARS-CoV-2 感染发展中的新型风险分层工具。

Novel Use Of Age-Adjusted Charlson Comorbidity Index (ACCI) As A Risk Stratification Tool For Development Of Postoperative SARS-COV-2 Infection In Surgical Patients.

机构信息

Health Education of England-North West Deanery, Manchester, United Kingdom.

North Cumbria Integrated Care, Carlisle, United Kingdom.

出版信息

J Ayub Med Coll Abbottabad. 2021 Oct-Dec;33(4):622-627.

PMID:35124920

Abstract

BACKGROUND

Current study documents the role of Age adjusted Charlson Comorbidity Index (ACCI) as a stratification tool for the development of postoperative SARS-CoV-2 infection in surgical patients.

METHODS

This prospective cohort study was conducted over the period of 8 weeks starting on 1st of March 2020. Sampling was convenience and purposive and included all consecutive patients who underwent any surgical procedure. Follow up period was 30 days. Outcomes included postoperative SARS-CoV-2 infection, morbidity and 30-day mortality. Risk factors for development of infection were detected by univariate and multivariate analysis.

RESULTS

Postoperative SARS-CoV-2 infection developed in 37 cases while 131cases remained confirmed negative. Of 37 patients, 18 were male while 19 were female. Postoperative complications developed in 17 patients (45.9%). In-hospital 30-day mortality was 16.2% (n=6). The factors that increased the chances of postoperative SARS-CoV-2 infection (p<0·00) included increasing age, higher ACCI Score, emergency surgery, trauma, orthopaedic and vascular procedures, spinal anaesthesia, and surgeries of complex nature. In adjusted analyses, predictors of postoperative infection included ACCI score of 4 or more (5.54 [1·51-20.34], p<0·01), and orthopaedics or vascular procedures versus others (12.32 [1.98-76.46], p<0·007). Based on infection rates across the different scores of ACCI, cohort was divided into 3 groups. ACCI score of zero had postoperative SARS-CoV-2 infection rate of 1.9 % (negative predictive value, 98.1%) compared with 36.26% in patients with score of 4 or more (sensitivity, 89.19%).

CONCLUSIONS

Low risk surgical patients (ACCI=0) should have universal precautions, while intermediate risk group (ACCI=1- 3) should have extra precautions. The options for high-risk patients (ACCI ≥4) include cancellation of nonurgent surgery; delaying the surgery till optimization of modifiable factors; or reverse isolation/ shielding in perioperative period if surgery cannot be cancelled.

摘要

背景

本研究记录了年龄调整 Charlson 合并症指数（ACCI）作为外科患者术后发生 SARS-CoV-2 感染的分层工具的作用。

方法

本前瞻性队列研究于 2020 年 3 月 1 日开始进行，为期 8 周。采用便利和目的性抽样，纳入所有接受任何手术的连续患者。随访时间为 30 天。研究结果包括术后 SARS-CoV-2 感染、发病率和 30 天死亡率。采用单因素和多因素分析检测感染发生的危险因素。

结果

37 例患者术后发生 SARS-CoV-2 感染，131 例患者确诊为阴性。37 例患者中，男性 18 例，女性 19 例。术后并发症 17 例（45.9%）。院内 30 天死亡率为 16.2%（n=6）。增加术后 SARS-CoV-2 感染几率的因素（p<0·00）包括年龄增长、ACCI 评分升高、急诊手术、创伤、骨科和血管手术、椎管内麻醉和复杂性质的手术。在调整分析中，术后感染的预测因素包括 ACCI 评分 4 分或以上（5.54[1.51-20.34]，p<0·01）和骨科或血管手术与其他手术（12.32[1.98-76.46]，p<0·007）。根据 ACCI 不同评分的感染率，将队列分为 3 组。ACCI 评分为 0 的患者术后 SARS-CoV-2 感染率为 1.9%（阴性预测值 98.1%），评分为 4 分或以上的患者感染率为 36.26%（敏感性 89.19%）。