[新型冠状病毒肺炎死亡预测。两种量表的比较]
[COVID-19 mortality prediction. Comparison between two scales].
作者信息
Arce-Zepeda Alberto, Araiza-Aguirre Armando Geovanni
机构信息
Instituto Mexicano del Seguro Social, Hospital General Regional No. 46, Coordinación Clínica de Educación e Investigación en Salud. Guadalajara, Jalisco, México.
Instituto Mexicano del Seguro Social, Hospital General Regional No. 46, Área de Urgencias. Guadalajara, Jalisco, México.
出版信息
Rev Med Inst Mex Seguro Soc. 2022 Jul 4;60(4):447-452.
BACKGROUND
The prognosis and mortality in patients with COVID-19 are variable. The NEWS2 (National Early Warning Score) and REMS (Rapid Emergency Medicine Score) scales can be used quickly at hospital admission to predict mortality, no studies have been found that compare their predictive performance in our population.
OBJECTIVE
To compare NEWS2 and REMS to predict mortality in patients with COVID-19.
MATERIAL AND METHODS
Retrospective cohort with 361 patients. The variables were collected to calculate the NEWS2 and REMS scales and the reason for hospital discharge. The predictive value for mortality was analyzed using the ROC curve, establishing the area under the curve (AUC) with 95% confidence intervals (95% CI). The cut-off point (PC) with the best sensitivity and specificity, positive predictive value (PPV) and negative predictive value (NPV), as well as relative risk (RR) with 95% CI.
RESULTS
The AUC of NEWS2 and REMS were 0.929 (95% CI: 0.903-0.956) and 0.913 (95% CI: 0.884-0.943), respectively. The PC of the NEWS2 scale was 8 points, with sensitivity 87.8% and specificity 82.1%, PPV 69.7% and NPV 93.5% and of the REMS scale of 7 points, with sensitivity 83.5% and specificity 83.7%, PPV 70.5% and NPV 91.6%. 8 or more points on the NEWS2 scale presenting a RR of 10.74 (95% CI: 6.4-18.03), and REMS 7 or more points RR 8.36 (95% CI: 5.36-13.02).
CONCLUSION
Both tests presented good discriminative ability to predict mortality, being better according to AUC and RR in the NEWS2 scale.
背景
新型冠状病毒肺炎（COVID-19）患者的预后和死亡率各不相同。国家早期预警评分（NEWS2）和快速急诊医学评分（REMS）量表可在患者入院时快速使用以预测死亡率，但尚未发现有研究比较它们在我国人群中的预测性能。
目的
比较NEWS2和REMS对COVID-19患者死亡率的预测能力。
材料与方法
对361例患者进行回顾性队列研究。收集变量以计算NEWS2和REMS量表以及出院原因。使用ROC曲线分析死亡率的预测价值，确定曲线下面积（AUC）及95%置信区间（95%CI）。确定具有最佳敏感性和特异性的截断点（PC）、阳性预测值（PPV）和阴性预测值（NPV），以及95%CI的相对风险（RR）。
结果
NEWS2和REMS的AUC分别为0.929（95%CI：0.903 - 0.956）和0.913（95%CI：0.884 - 0.943）。NEWS2量表的PC为8分，敏感性为87.8%，特异性为82.1%，PPV为69.7%，NPV为93.5%；REMS量表的PC为7分，敏感性为83.5%，特异性为83.7%，PPV为70.5%，NPV为91.6%。NEWS2量表8分及以上的RR为10.74（95%CI：6.4 - 18.03），REMS量表7分及以上的RR为8.36（9%CI：5.36 - 13.02）。
结论
两种测试在预测死亡率方面均具有良好的判别能力，根据AUC和RR，NEWS2量表表现更佳。
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