Faculty of Medicine, University of Geneva, Geneve, Switzerland.
Department of Medical Imaging and Medical Information Sciences, Geneva University Hospitals, Geneve, Switzerland.
BMJ Open Respir Res. 2022 Aug;9(1). doi: 10.1136/bmjresp-2022-001340.
The SARS-CoV-2 pandemic led to a steep increase in hospital and intensive care unit (ICU) admissions for acute respiratory failure worldwide. Early identification of patients at risk of clinical deterioration is crucial in terms of appropriate care delivery and resource allocation. We aimed to evaluate and compare the prognostic performance of Sequential Organ Failure Assessment (SOFA), Quick Sequential Organ Failure Assessment (qSOFA), Confusion, Uraemia, Respiratory Rate, Blood Pressure and Age ≥65 (CURB-65), Respiratory Rate and Oxygenation (ROX) index and Coronavirus Clinical Characterisation Consortium (4C) score to predict death and ICU admission among patients admitted to the hospital for acute COVID-19 infection.
Consecutive adult patients admitted to the Geneva University Hospitals during two successive COVID-19 flares in spring and autumn 2020 were included. Discriminative performance of these prediction rules, obtained during the first 24 hours of hospital admission, were computed to predict death or ICU admission. We further exluded patients with therapeutic limitations and reported areas under the curve (AUCs) for 30-day mortality and ICU admission in sensitivity analyses.
A total of 2122 patients were included. 216 patients (10.2%) required ICU admission and 303 (14.3%) died within 30 days post admission. 4C score had the best discriminatory performance to predict 30-day mortality (AUC 0.82, 95% CI 0.80 to 0.85), compared with SOFA (AUC 0.75, 95% CI 0.72 to 0.78), qSOFA (AUC 0.59, 95% CI 0.56 to 0.62), CURB-65 (AUC 0.75, 95% CI 0.72 to 0.78) and ROX index (AUC 0.68, 95% CI 0.65 to 0.72). ROX index had the greatest discriminatory performance (AUC 0.79, 95% CI 0.76 to 0.83) to predict ICU admission compared with 4C score (AUC 0.62, 95% CI 0.59 to 0.66), CURB-65 (AUC 0.60, 95% CI 0.56 to 0.64), SOFA (AUC 0.74, 95% CI 0.71 to 0.77) and qSOFA (AUC 0.59, 95% CI 0.55 to 0.62).
Scores including age and/or comorbidities (4C and CURB-65) have the best discriminatory performance to predict mortality among inpatients with COVID-19, while scores including quantitative assessment of hypoxaemia (SOFA and ROX index) perform best to predict ICU admission. Exclusion of patients with therapeutic limitations improved the discriminatory performance of prognostic scores relying on age and/or comorbidities to predict ICU admission.
SARS-CoV-2 大流行导致全球因急性呼吸衰竭而住院和入住重症监护病房（ICU）的人数急剧增加。早期识别有临床恶化风险的患者对于提供适当的护理和资源分配至关重要。我们旨在评估和比较序贯器官衰竭评估（SOFA）、快速序贯器官衰竭评估（qSOFA）、意识模糊、肾衰竭、呼吸急促、血压和年龄≥65 岁（CURB-65）、呼吸急促和氧合指数（ROX 指数）和冠状病毒临床特征联盟（4C）评分在预测急性 COVID-19 感染患者死亡和入住 ICU 方面的预后性能。
连续纳入 2020 年春季和秋季两次 COVID-19 流行期间在日内瓦大学医院住院的成年患者。在入院后 24 小时内获得这些预测规则的鉴别性能，以预测死亡或 ICU 入院。我们进一步排除了有治疗限制的患者，并在敏感性分析中报告了 30 天死亡率和 ICU 入院的曲线下面积（AUCs）。
共纳入 2122 例患者。216 例（10.2%）需要入住 ICU，303 例（14.3%）在入院后 30 天内死亡。4C 评分在预测 30 天死亡率方面具有最佳的鉴别性能（AUC 0.82，95%CI 0.80 至 0.85），而 SOFA（AUC 0.75，95%CI 0.72 至 0.78）、qSOFA（AUC 0.59，95%CI 0.56 至 0.62）、CURB-65（AUC 0.75，95%CI 0.72 至 0.78）和 ROX 指数（AUC 0.68，95%CI 0.65 至 0.72）。ROX 指数在预测 ICU 入院方面具有最大的鉴别性能（AUC 0.79，95%CI 0.76 至 0.83），而 4C 评分（AUC 0.62，95%CI 0.59 至 0.66）、CURB-65（AUC 0.60，95%CI 0.56 至 0.64）、SOFA（AUC 0.74，95%CI 0.71 至 0.77）和 qSOFA（AUC 0.59，95%CI 0.55 至 0.62）。
包括年龄和/或合并症的评分（4C 和 CURB-65）在预测 COVID-19 住院患者的死亡率方面具有最佳的鉴别性能，而包括低氧血症定量评估的评分（SOFA 和 ROX 指数）在预测 ICU 入院方面表现最佳。排除有治疗限制的患者可提高基于年龄和/或合并症的预后评分预测 ICU 入院的鉴别性能。
