Oliva Alessandra, Borrazzo Cristian, Mascellino Maria Teresa, Curtolo Ambrogio, Al Ismail Dania, Cancelli Francesca, Galardo Gioacchino, Bucci Tommaso, Ceccarelli Giancarlo, d'Ettorre Gabriella, Pugliese Francesco, Mastroianni Claudio M, Venditti Mario
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome Italy.
Medical Emergency Unit, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
Infez Med. 2021 Sep 10;29(3):408-415. doi: 10.53854/liim-2903-12. eCollection 2021.
There is the need of a simple but highly reliable score system for stratifying the risk of mortality and Intensive Care Unit (ICU) transfer in patients with SARS-CoV-2 pneumonia at the Emergency Room.
In this study, the ability of CURB-65, extended CURB-65, PSI and CALL scores and C-Reactive Protein (CRP) to predict intra-hospital mortality and ICU admission in patients with SARS-CoV-2 pneumonia were evaluated.
During March-May 2020, a retrospective, single-center study including all consecutive adult patients with diagnosis of SARS-CoV-2 pneumonia was conducted. Clinical, laboratory and radiological data as well as CURB-65, expanded CURB-65, PSI and CALL scores were calculated based on data recorded at hospital admission.
Overall, 224 patients with documented SARS-CoV-2 pneumonia were included in the study. As for intrahospital mortality (24/224, 11%), PSI performed better than all the other tested scores, which showed lower AUC values (AUC=0.890 for PSI AUC=0.885, AUC=0.858 and AUC=0.743 for expanded CURB-65, CURB-65 and CALL scores, respectively). Of note, the addition of hypoalbuminemia to the CURB-65 score increased the prediction value of intra-hospital mortality (AUC=0.905). All the tested scores were less predictive for the need of ICU transfer (26/224, 12%), with the best AUC for extended CURB-65 score (AUC= 0.708).
The addition of albumin level to the easy-to-calculate CURB-65 score at hospital admission is able to improve the quality of prediction of intra-hospital mortality in patients with SARS-CoV-2 pneumonia.
在急诊室，需要一个简单但高度可靠的评分系统来对感染新型冠状病毒肺炎患者的死亡风险和重症监护病房（ICU）转运风险进行分层。
在本研究中，评估了CURB-65、扩展CURB-65、肺炎严重指数（PSI）、社区获得性肺炎患者死亡风险评估（CALL）评分以及C反应蛋白（CRP）预测新型冠状病毒肺炎患者院内死亡和入住ICU的能力。
在2020年3月至5月期间，进行了一项回顾性单中心研究，纳入所有连续诊断为新型冠状病毒肺炎的成年患者。根据入院时记录的数据计算临床、实验室和放射学数据以及CURB-65、扩展CURB-65、PSI和CALL评分。
总体而言，本研究纳入了224例确诊新型冠状病毒肺炎的患者。关于院内死亡率（24/224，11%），PSI的表现优于所有其他测试评分，其他评分的曲线下面积（AUC）值较低（PSI的AUC=0.890；扩展CURB-65、CURB-65和CALL评分的AUC分别为0.885、0.858和0.743）。值得注意的是，将低白蛋白血症纳入CURB-65评分可提高院内死亡率的预测价值（AUC=0.905）。所有测试评分对ICU转运需求（26/224，12%）的预测性均较低，扩展CURB-65评分的AUC最高（AUC=0.708）。
在入院时将白蛋白水平纳入易于计算的CURB-65评分，能够提高新型冠状病毒肺炎患者院内死亡率的预测质量。
