验证 PRIORITY 模型在预测接种疫苗和未接种疫苗患者 COVID-19 重症中的有效性。
External validation of the PRIORITY model in predicting COVID-19 critical illness in vaccinated and unvaccinated patients.
机构信息
National Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.
National Centre for Infectious Diseases, Singapore.
出版信息
Clin Microbiol Infect. 2022 Jun;28(6):884.e1-884.e3. doi: 10.1016/j.cmi.2022.01.031. Epub 2022 Feb 10.
OBJECTIVES
Predictive scores are important tools for the triage of patients with coronavirus disease 2019. The PRIORITY score is advantageous because it does not require laboratory and radiologic information. However, the original development and validation cohorts studied only unvaccinated patients in early 2020. We aimed to externally validate the PRIORITY score in a cohort of patients with the novel delta and omicron variants of coronavirus disease 2019 and mixed vaccination status.
METHODS
A total of 410 patients were included in a cross-sectional sampling of all patients admitted to the National Centre of Infectious Diseases on October 27, 2021. A further 102 and 136 patients with vaccine-breakthrough Delta and Omicron variant infection from April to August and December 2021, respectively, were also included. Variables at the time of admission were collected retrospectively from medical records and used to calculate the probability of deterioration using the PRIORITY model.
RESULTS
Of the total 648 included patients, 447 (69.0%) were vaccinated. The mean age was 61.6 years (standard deviation ± 19.0 years), and 268 patients (41.4%) were female. A total of 112 patients (17.3%) met the primary outcome of developing critical illness or mortality. The performance of the score in this cohort was comparable with the original cohorts, with an area under the receiver operating characteristic curve for all patients of 0.794 (95% CI, 0.752-0.835; p < 0.001), regression coefficient of 1.069, and intercept of 0.04. Subgroup analysis of unvaccinated and vaccinated patients showed that performance was superior in vaccinated individuals, with an area under the receiver operating characteristic curve of 0.684 (95% CI, 0.608-0.760; p < 0.0001) and 0.831 (95% CI, 0.772-0.891; p < 0.0001), respectively.
DISCUSSION
Our data support the continued use of the PRIORITY score in this era of novel variants and increased vaccination uptake.
目的
预测评分是对 2019 年冠状病毒病患者进行分诊的重要工具。PRIORITY 评分具有优势，因为它不需要实验室和影像学信息。然而，最初的开发和验证队列仅研究了 2020 年初未接种疫苗的患者。我们旨在对 2019 年新型德尔塔和奥密克戎变异株以及混合疫苗接种状态的患者进行 PRIORITY 评分的外部验证。
方法
2021 年 10 月 27 日，对国家传染病中心所有入院患者进行横断面抽样，共纳入 410 例患者。此外，还纳入了 2021 年 4 月至 8 月和 12 月分别因突破性德尔塔和奥密克戎变异株感染而接受疫苗接种的 102 例和 136 例患者。从病历中回顾性收集入院时的变量，并使用 PRIORITY 模型计算恶化的概率。
结果
在总共纳入的 648 例患者中，447 例（69.0%）接种了疫苗。平均年龄为 61.6 岁（标准差±19.0 岁），268 例（41.4%）为女性。共有 112 例（17.3%）患者出现了发展为危重症或死亡的主要结局。该评分在该队列中的表现与原始队列相当，所有患者的受试者工作特征曲线下面积为 0.794（95%CI，0.752-0.835；p<0.001），回归系数为 1.069，截距为 0.04。未接种疫苗和接种疫苗患者的亚组分析显示，在接种疫苗的个体中表现更好，受试者工作特征曲线下面积分别为 0.684（95%CI，0.608-0.760；p<0.0001）和 0.831（95%CI，0.772-0.891；p<0.0001）。
讨论
我们的数据支持在新型变异株和疫苗接种率增加的时代继续使用 PRIORITY 评分。
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