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COVID-19 患者住院和长期死亡率及病情进展的重要预测因子:终末期肝病(MELD)评分模型。

A significant predictor of in-hospital and long-term mortality and progression in COVID-19 patients: The end-stage liver disease (MELD) score model.

机构信息

Department of Internal Medicine, Ordu University Medical Faculty, Ordu, Turkey.

Erzurum Regional Training and Research Hospital, Erzurum, Turkey.

出版信息

J Med Virol. 2023 Jan;95(1):e28109. doi: 10.1002/jmv.28109. Epub 2022 Sep 10.

Abstract

The aim of this study is to investigate the relationship between the model for end-stage liver disease (MELD) score and disease progression and mortality in COVID-19 patients. The files of 4213 patients over the age of 18 who were hospitalized with the diagnosis of COVID-19 between March 20, 2020 and May 1, 2021 were retrospectively scanned. Sociodemographic characteristics, chronic diseases, hemogram and biochemical parameters at the time they were diagnosed with COVID-19 of the patients, duration of hospitalization, duration of intensive care unit (ICU), duration of intubation, in-hospital mortality from COVID-19 and outside-hospital mortality for another reason (within the last 1 year) and recurrent hospitalization (within the last 1 year) were recorded. The MELD scores of the patients were calculated. Two groups were formed as MELD score < 10 and MELD score ≥ 10. The rate of ICU, in-hospital mortality from COVID-19 and outside-hospital mortality from other causes, intubation rate, and recurrent hospitalization were significantly higher in the MELD ≥ 10 group. The duration of ICU, hospitalization, intubation were significantly higher in the MELD ≥ 10 group (p < 0.001). As a result of Univariate and Multivariate analysis, MELD score was found to be the independent predictors of ICU, in-hospital mortality, intubation, and recurrent hospitalization (p < 0.001). MELD score 18.5 predicted ICU with 99% sensitivity and 100% specificity (area under curve [AUC]: 0.740, 95% confidence interval [CI]: 0.717-0.763, p < 0.001) also MELD score 18.5 predicted in-hospital mortality with 99% sensitivity and 100% specificity (AUC: 0.797, 95% CI: 0.775-0.818, p < 0.001). The MELD score was found to be the independent predictors of in-hospital mortality, ICU admission, and intubation in COVID-19 patients.

摘要

本研究旨在探讨终末期肝病模型(MELD)评分与 COVID-19 患者疾病进展和死亡率之间的关系。回顾性扫描了 2020 年 3 月 20 日至 2021 年 5 月 1 日期间因 COVID-19 住院的 4213 名年龄在 18 岁以上患者的病历。记录了患者的社会人口统计学特征、慢性疾病、COVID-19 诊断时的血常规和生化参数、住院时间、重症监护病房(ICU)时间、插管时间、COVID-19 院内死亡率和因其他原因(在过去 1 年内)的院外死亡率以及(在过去 1 年内)的再次住院率。计算了患者的 MELD 评分。将患者分为 MELD 评分<10 和 MELD 评分≥10 两组。MELD 评分≥10 组的 ICU 入住率、COVID-19 院内死亡率、其他原因的院外死亡率、插管率和再次住院率均显著升高。MELD 评分≥10 组的 ICU 持续时间、住院时间和插管时间显著更长(p<0.001)。单因素和多因素分析结果显示,MELD 评分是 ICU、院内死亡率、插管和再次住院的独立预测因素(p<0.001)。MELD 评分 18.5 预测 ICU 的敏感性为 99%,特异性为 100%(曲线下面积[AUC]:0.740,95%置信区间[CI]:0.717-0.763,p<0.001),MELD 评分 18.5 预测院内死亡率的敏感性为 99%,特异性为 100%(AUC:0.797,95%CI:0.775-0.818,p<0.001)。MELD 评分是 COVID-19 患者院内死亡率、ICU 入住和插管的独立预测因素。

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