Emergency Department, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
Intern Emerg Med. 2022 Nov;17(8):2357-2365. doi: 10.1007/s11739-022-03047-0. Epub 2022 Jul 27.
Periodic surges of COVID-19 patients seeking care in the hospital environment overwhelm systems reduce the availability of resources for treatment of non-COVID-19 cases (Zheng et al. in J Hosp Infect 106:325-329, 2020). Hospital flow and resource management could be greatly enhanced by differentiating patients who are likely at risk of adverse clinical outcomes from those who could safely be discharged after evaluation and managed outside of the hospital setting (Sun et al. in J Infect Dis 223:38-46, 2021). Herein, we propose a prognostic score named PEGALUS (Predictivity of Elderly age, arterial blood Gas Analysis and Lung UltraSound) that could potentially help clinicians properly and rapidly choose the appropriate allocation of COVID-19 patients admitted to the emergency department (ED).
This observational prospective study enrolled COVID-19 patients who were admitted to the ED of IRCCS San Raffaele Hospital (HSR).
230 COVID-19 patients were enrolled and 30-day follow-up data was collected. Composite outcome was death or need for oro-tracheal intubation (OTI). 50 patients (21.5%) reached the outcome during the observational period. In multivariate Cox analysis, age, PO/FiO ratio, pCO, duration of symptoms, and lung ultrasound evaluation were significantly associated with the adverse outcome. We obtained a new scorecard (PEGALUS) according to the hazard ratio of the identified predictors. PEGALUS score performed well in predicting the composite outcome (AUC 0.866, 95% IC 0.812-0.921; p < 0.001). Kaplan-Meier showed that a PEGALUS score < 7 was associated with a good 30-day prognosis (survival rate 97.5%), compared to a PEGALUS score of 7-11 (survival rate 85.9%; p log-rank 0.009) and PEGALUS score > 11 (survival rate 49.3%; p log-rank < 0.001).
PEGALUS score performed at the admission can predict adverse outcomes in patients with COVID-19. The systematic application of this score might permit a more accurate and rapid treatment allocation in this setting.
COVID-19 患者在医院环境中周期性寻求治疗，导致系统不堪重负，减少了非 COVID-19 病例的治疗资源可用性（Zheng 等人，J Hosp Infect 106:325-329, 2020）。通过区分可能有不良临床结局风险的患者和经过评估后可在医院外安全出院的患者，可大大增强医院流程和资源管理（Sun 等人，J Infect Dis 223:38-46, 2021）。在此，我们提出了一个名为 PEGALUS 的预后评分，它可能有助于临床医生正确快速地选择 COVID-19 患者在急诊科（ED）的适当分配。
本观察性前瞻性研究纳入了收入 IRCCS San Raffaele 医院（HSR）ED 的 COVID-19 患者。
共纳入 230 例 COVID-19 患者，收集了 30 天随访数据。复合结局为死亡或需要经口气管插管（OTI）。在观察期间，50 例患者（21.5%）达到了这一结果。多变量 Cox 分析显示，年龄、PO/FiO 比值、pCO、症状持续时间和肺部超声评估与不良结局显著相关。根据确定的预测因素的风险比，我们获得了一个新的评分卡（PEGALUS）。PEGALUS 评分在预测复合结局方面表现良好（AUC 0.866，95%CI 0.812-0.921；p<0.001）。Kaplan-Meier 分析显示，PEGALUS 评分<7 与 30 天预后良好（生存率 97.5%）相关，而 PEGALUS 评分 7-11（生存率 85.9%；p log-rank 0.009）和 PEGALUS 评分>11（生存率 49.3%；p log-rank<0.001）。
PEGALUS 评分在入院时可预测 COVID-19 患者的不良结局。该评分的系统应用可能允许在这种情况下更准确和快速地进行治疗分配。
