巴西东北部危重症 COVID-19 患者：包括 SAPS 3 在内的第一波和第二波期间的死亡率预测因素。
Critically ill COVID-19 patients in northeast Brazil: mortality predictors during the first and second waves including SAPS 3.
机构信息
University of Fortaleza, Av. Washington Soares, 1321, Fortaleza, CE, 60811-905, Brazil.
Post-Graduate Program in Public Health, University of Fortaleza, Av. Washington Soares, 1321, Fortaleza, CE, 60811-905, Brazil.
出版信息
Trans R Soc Trop Med Hyg. 2022 Nov 1;116(11):1054-1062. doi: 10.1093/trstmh/trac046.
BACKGROUND
The Simplified Acute Physiology Score (SAPS) 3 is a reliable score to predict mortality. This study aims to investigate the predictive values of SAPS 3 and other clinical parameters for death in critically ill coronavirus disease 2019 (COVID-19) patients.
METHODS
This is a prospective study in a tertiary hospital for patients who required intensive care due to COVID-19 infection in northeast Brazil. Two distinct groups were constructed according to the epidemiological data: first wave and second wave. The severity of patients admitted was estimated using the SAPS 3 score.
RESULTS
A total of 767 patients were included: 290 were enrolled in the first wave and 477 in the second wave. Patients in the first wave had more comorbidities, were put on mechanical ventilation and required dialysis and vasopressors more frequently (p<0.05). During the second wave, non-invasive ventilation was more often required (p<0.05). In both periods, older patients and higher SAPS 3 scores on admission were associated with death (p<0.05). Non-invasive ventilation use showed a negative association with death only in the second wave period. In the first wave, the SAPS 3 score was more useful (area under the curve [AUC] 0.897) in predicting death in critically ill COVID-19 patients than in the second wave (AUC 0.810).
CONCLUSION
The SAPS 3 showed very reliable predictive values for death during the waves of the COVID-19 pandemic, mostly together with kidney and pulmonary dysfunction.
背景
简化急性生理学评分（SAPS）3 是一种可靠的预测死亡率的评分。本研究旨在探讨 SAPS 3 和其他临床参数对新冠肺炎（COVID-19）危重症患者死亡的预测价值。
方法
这是巴西东北部一家三级医院对因 COVID-19 感染而需要重症监护的患者进行的前瞻性研究。根据流行病学数据构建了两个不同的组：第一波和第二波。使用 SAPS 3 评分评估患者入院时的严重程度。
结果
共纳入 767 例患者：第一波 290 例，第二波 477 例。第一波患者合并症更多，更常接受机械通气，更频繁地需要透析和血管加压素（p<0.05）。在第二波期间，更常需要无创通气（p<0.05）。在两个时期，年龄较大和入院时 SAPS 3 评分较高的患者与死亡相关（p<0.05）。仅在第二波期间，无创通气的使用与死亡呈负相关。在第一波中，SAPS 3 评分在预测 COVID-19 危重症患者死亡方面比第二波（AUC 0.810）更有用（曲线下面积 [AUC] 0.897）。
结论
SAPS 3 在 COVID-19 大流行期间对死亡具有非常可靠的预测价值，主要与肾脏和肺部功能障碍有关。
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