Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
Clin Microbiol Infect. 2023 Mar;29(3):379-385. doi: 10.1016/j.cmi.2022.09.019. Epub 2022 Sep 30.
To identify predictors of 30-day survival in elderly patients with coronavirus disease 2019 (COVID-19).
Retrospective cohort study including patients with COVID-19 aged ≥65 years hospitalized in six European sites (January 2020 to May 2021). Data on demographics, comorbidities, clinical characteristics, and outcomes were collected. A predictive score (FLAMINCOV) was developed using logistic regression. Regression coefficients were used to calculate the score. External validation was performed in a cohort including elderly patients from a major COVID-19 centre in Israel. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUC) in the derivation and validation cohorts. Survival risk groups based on the score were derived and applied to the validation cohort.
Among 3010 patients included in the derivation cohort, 30-day survival was 74.5% (2242/3010). The intensive care unit admission rate was 7.6% (228/3010). The model predicting survival included independent functional status (OR, 4.87; 95% CI, 3.93-6.03), a oxygen saturation to fraction of inspired oxygen (SpO/FiO ratio of >235 (OR, 3.75; 95% CI, 3.04-4.63), a C-reactive protein level of <14 mg/dL (OR, 2.41; 95% CI, 1.91-3.04), a creatinine level of <1.3 (OR, 2.02; 95% CI, 1.62-2.52) mg/dL, and absence of fever (OR, 1.34; 95% CI, 1.09-1.66). The score was validated in 1174 patients. The FLAMINCOV score ranges from 0 to 15 and showed good discrimination in the derivation (AUC, 0.79; 95% CI, 0.77-0.81; p < 0.001) and validation cohorts (AUC, 0.79; 95% CI, 0.76-0.81; p < 0.001). Thirty-day survival ranged from 39.4% (203/515) to 95.3% (634/665) across four risk groups according to score quartiles in the derivation cohort. Similar proportions were observed in the validation set.
The FLAMINCOV score identifying elderly with higher or lower chances of survival may allow better triage and management, including intensive care unit admission/exclusion.
确定 2019 年冠状病毒病（COVID-19）老年患者 30 天生存率的预测因素。
本回顾性队列研究纳入了 6 个欧洲地点（2020 年 1 月至 2021 年 5 月）住院的年龄≥65 岁的 COVID-19 患者。收集了人口统计学、合并症、临床特征和结局数据。使用逻辑回归开发了预测评分（FLAMINCOV）。回归系数用于计算评分。使用来自以色列一个主要 COVID-19 中心的老年患者队列进行外部验证。在推导和验证队列中，使用接受者操作特征曲线（ROC）下面积（AUC）评估区分度。根据评分衍生出基于风险的生存组，并将其应用于验证队列。
在纳入推导队列的 3010 名患者中，30 天生存率为 74.5%（2242/3010）。入住重症监护病房的比例为 7.6%（228/3010）。预测生存的模型包括独立的功能状态（OR，4.87；95%CI，3.93-6.03）、氧饱和度与吸入氧分数（SpO/FiO 比值>235（OR，3.75；95%CI，3.04-4.63）、C 反应蛋白水平<14mg/dL（OR，2.41；95%CI，1.91-3.04）、肌酐水平<1.3mg/dL（OR，2.02；95%CI，1.62-2.52）和无发热（OR，1.34；95%CI，1.09-1.66）。该评分在 1174 名患者中得到验证。FLAMINCOV 评分范围为 0 至 15 分，在推导队列（AUC，0.79；95%CI，0.77-0.81；p<0.001）和验证队列（AUC，0.79；95%CI，0.76-0.81；p<0.001）中均具有良好的区分度。根据推导队列四分位数评分，四个风险组的 30 天生存率范围为 39.4%（203/515）至 95.3%（634/665）。在验证组中也观察到了类似的比例。
FLAMINCOV 评分可识别生存率较高或较低的老年患者，从而可以更好地进行分诊和管理，包括入住重症监护病房或排除。
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