衰弱对国家早期预警评分 2 预测因 COVID-19 住院患者不良结局的性能的影响。

Impact of frailty on the performance of the National Early Warning Score 2 to predict poor outcome in patients hospitalised due to COVID-19.

机构信息

Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Post Box 800, 3004, Drammen, Norway.

Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway.

出版信息

BMC Geriatr. 2023 Mar 8;23(1):134. doi: 10.1186/s12877-023-03842-0.

DOI:10.1186/s12877-023-03842-0

PMID:36890484

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9994778/

Abstract

BACKGROUND

The National Early Warning Score 2 (NEWS2) is a scoring tool predictive of poor outcome in hospitalised patients. Older patients with COVID-19 have increased risk of poor outcome, but it is not known if frailty may impact the predictive performance of NEWS2. We aimed to investigate the impact of frailty on the performance of NEWS2 to predict in-hospital mortality in patients hospitalised due to COVID-19.

METHODS

We included all patients admitted to a non-university Norwegian hospital due to COVID-19 from 9 March 2020 until 31 December 2021. NEWS2 was scored based on the first vital signs recorded upon hospital admission. Frailty was defined as a Clinical Frailty Scale score ≥ 4. The performance of a NEWS2 score ≥ 5 to predict in-hospital mortality was assessed with sensitivity, specificity and area under the receiver operating characteristic curve (AUROC) according to frailty status.

RESULTS

Out of 412 patients, 70 were aged ≥ 65 years and with frailty. They presented less frequently with respiratory symptoms, and more often with acute functional decline or new-onset confusion. In-hospital mortality was 6% in patients without frailty, and 26% in patients with frailty. NEWS2 predicted in-hospital mortality with a sensitivity of 86%, 95% confidence interval (CI) 64%-97% and AUROC 0.73, 95% CI 0.65-0.81 in patients without frailty. In older patients with frailty, sensitivity was 61%, 95% CI 36%-83% and AUROC 0.61, 95% CI 0.48-0.75.

CONCLUSION

A single NEWS2 score at hospital admission performed poorly to predict in-hospital mortality in patients with frailty and COVID-19 and should be used with caution in this patient group. Graphical abstract summing up study design, results and conclusion.

摘要

背景

国家早期预警评分 2 版（NEWS2）是一种预测住院患者不良预后的评分工具。患有 COVID-19 的老年患者发生不良预后的风险增加，但尚不清楚虚弱是否会影响 NEWS2 的预测性能。我们旨在研究虚弱对 NEWS2 预测 COVID-19 住院患者院内死亡率的性能的影响。

方法

我们纳入了 2020 年 3 月 9 日至 2021 年 12 月 31 日期间因 COVID-19 入住挪威非大学医院的所有患者。NEWS2 基于入院时首次记录的生命体征进行评分。虚弱定义为临床虚弱量表评分≥4。根据虚弱状态评估 NEWS2 评分≥5 预测院内死亡率的性能，包括敏感性、特异性和受试者工作特征曲线下面积（AUROC）。

结果

在 412 名患者中，有 70 名年龄≥65 岁且伴有虚弱。他们较少出现呼吸症状，而更多出现急性功能下降或新发意识混乱。无虚弱的患者院内死亡率为 6%，有虚弱的患者为 26%。NEWS2 在无虚弱的患者中预测院内死亡率的敏感性为 86%，95%置信区间（CI）为 64%-97%，AUROC 为 0.73，95%CI 为 0.65-0.81。在伴有虚弱的老年患者中，敏感性为 61%，95%CI 为 36%-83%，AUROC 为 0.61，95%CI 为 0.48-0.75。