Department of Emergency Medicine, Marmara University Pendik Research and Training Hospital, 34890 Istanbul, Turkey.
Department of Emergency Medicine, Marmara University Pendik Research and Training Hospital, 34890 Istanbul, Turkey.
Am J Emerg Med. 2022 Oct;60:50-56. doi: 10.1016/j.ajem.2022.07.025. Epub 2022 Jul 16.
Identifying which patients with COVİD-19 have a high risk of severe illness is essential to optimizing management and resource utilization strategies.
The aim of this study was to externally validate the diagnostic utility of the Covichem score for predicting COVID-19 disease severity, and secondarily to evaluate its utility in predicting intensive care unit (ICU) admission, and in-hospital mortality.
All consecutive COVID-19 patients who presented to the emergency department (ED) were included, and patients' demographic data, comorbidities, vital signs, oxygen requirement, and laboratory results were recorded. We calculated patients' Covichem scores and estimates (using a threshold of 0.5) and evaluated the utility of the Covichem score for predicting disease severity, ICU admission, and mortality.
The median Covichem score was significantly higher for patients with severe illness (Covichem score: 0.170, IQR: 0.298, n = 300 vs. Covichem score: 0.026, IQR: 0.065, n: 191; p < 0.001). Based on their Covichem scores, 12.4% (61/491) of the patients were predicted to experience severe illness (threshold: 0.5), the accuracy of the Covichem score was poor, as the area under curve (AUC) was 48.5% (18.1% sensitivity and 93.8% specificity). When we calculated a new ideal threshold, the AUC reached 82%, but the sensitivity was 79.9% and the specificity was 71.2%.
In this external validation of the Covichem score, we found that it performed worse than in the original derivation and validation study, even with the assistance of a new cutoff.
识别 COVID-19 患者中哪些有发生重症的高风险对于优化管理和资源利用策略至关重要。
本研究旨在外部验证 Covichem 评分预测 COVID-19 疾病严重程度的诊断效用，并评估其在预测重症监护病房（ICU）入住和院内死亡率方面的效用。
所有连续因 COVID-19 就诊于急诊科（ED）的患者均被纳入研究，记录患者的人口统计学数据、合并症、生命体征、氧气需求和实验室结果。我们计算了患者的 Covichem 评分和估计值（使用阈值为 0.5），并评估了 Covichem 评分预测疾病严重程度、ICU 入住和死亡率的效用。
严重疾病患者的 Covichem 评分中位数显著更高（Covichem 评分：0.170，IQR：0.298，n = 300 与 Covichem 评分：0.026，IQR：0.065，n = 191；p < 0.001）。根据他们的 Covichem 评分，有 12.4%（61/491）的患者被预测为患有严重疾病（阈值：0.5），Covichem 评分的准确性较差，曲线下面积（AUC）为 48.5%（敏感度为 18.1%，特异性为 93.8%）。当我们计算新的理想阈值时，AUC 达到 82%，但敏感度为 79.9%，特异性为 71.2%。
在对 Covichem 评分的外部验证中，我们发现其表现不如原始推导和验证研究中好，即使有新的截断值的帮助。
