Jamil Zubia, Samreen Saba, Mukhtar Bisma, Khaliq Madiha, Abbasi Shahid Mumtaz, Ahmed Jamal, Hussain Tassawar
Department of Medicine, Foundation University Medical College, Foundation University, DHA Phase 1 Islamabad, Pakistan.
Foundation University Medical College, Foundation University, DHA Phase 1 Islamabad, Pakistan.
Eurasian J Med. 2022 Oct;54(3):213-218. doi: 10.5152/eurasianjmed.2021.21149.
To date, there is no specific validated coronavirus disease 2019 score to assess the disease severity. This study aimed to evaluate the performance of the National Early Warning Score, Sequential Organ Failure Assessment, and Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase scores in predicting the in-hospital outcome of critical or severe coronavirus disease 2019 patients.
Single-centered analytical study was carried out in the coronavirus disease 2019 high dependency unit from April to August 2020. National Early Warning Score, Sequential Organ Failure Assessment, and Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase scores were calculated for each critical to severely ill coronavirus disease 2019 patient. The diagnostic accuracy of these 3 scores in determining the in-hospital outcome of coronavirus disease 2019 patients was assessed by area under the receiver operating characteristic curve. The cut-off value of each score along with sensitivity, specificity, and positive and negative likelihood ratio were calculated by Youden index. Predictors of outcome in coronavirus disease 2019 patients were analyzed by Cox-regression analysis.
The area under the curve was highest for the Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase score (area under the curve=0.85) while the Sequential Organ Failure Assessment score had an area under the curve of 0.72. The cut-off values for National Early Warning Score score was 8 (sensitivity=72.34%, specificity=76.10%), Sequential Organ Failure Assessment score was 3 (sensitivity=68.97%, specificity=67.42%), and Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase score was 8 (sensitivity=88.89%, specificity=66.67%). The pairwise comparison showed that the difference between the area under the curve of these 3 scores was statistically insignificant (P > .05). The rate of mortality and invasive ventilation was significantly high in groups with high National Early Warning Score, Sequential Organ Failure Assessment, and Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase scores (P > .0001). These 3 scores, age, low platelets, and high troponin-T levels were found to be statistically significant predictors of outcome Conclusion:Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase score had a good area under the curve, the highest sensitivity of its cut-off value, required only 4 parameters, and is easy to calculate so it may be a better tool among the 3 scores in outcome prediction for coronavirus disease 2019 patients.
迄今为止，尚无经过验证的用于评估2019冠状病毒病严重程度的特定评分系统。本研究旨在评估国家早期预警评分、序贯器官衰竭评估以及合并症-年龄-淋巴细胞计数-乳酸脱氢酶评分在预测2019冠状病毒病危重症或重症患者院内结局方面的表现。
于2020年4月至8月在2019冠状病毒病高依赖病房开展单中心分析性研究。为每位2019冠状病毒病危重症患者计算国家早期预警评分、序贯器官衰竭评估以及合并症-年龄-淋巴细胞计数-乳酸脱氢酶评分。通过受试者工作特征曲线下面积评估这3种评分在确定2019冠状病毒病患者院内结局方面的诊断准确性。采用约登指数计算每种评分的截断值以及敏感度、特异度、阳性似然比和阴性似然比。通过Cox回归分析对2019冠状病毒病患者结局的预测因素进行分析。
合并症-年龄-淋巴细胞计数-乳酸脱氢酶评分的曲线下面积最高（曲线下面积 = 0.85），而序贯器官衰竭评估评分的曲线下面积为0.72。国家早期预警评分的截断值为8（敏感度 = 72.34%，特异度 = 76.10%），序贯器官衰竭评估评分的截断值为3（敏感度 = 68.97%，特异度 = 67.42%），合并症-年龄-淋巴细胞计数-乳酸脱氢酶评分的截断值为8（敏感度 = 88.89%，特异度 = 66.67%）。两两比较显示，这3种评分的曲线下面积差异无统计学意义（P > .05）。国家早期预警评分、序贯器官衰竭评估以及合并症-年龄-淋巴细胞计数-乳酸脱氢酶评分较高的组死亡率和有创通气率显著更高（P > .0001）。发现这3种评分、年龄、低血小板计数和高肌钙蛋白T水平是结局的统计学显著预测因素。结论：合并症-年龄-淋巴细胞计数-乳酸脱氢酶评分曲线下面积良好，其截断值敏感度最高，仅需4个参数且易于计算，因此在预测2019冠状病毒病患者结局方面可能是这3种评分中较好的工具。
