沙特阿拉伯确诊感染新冠病毒的住院患者的CURB-65和ISARIC 4C死亡评分表现。
Performance of CURB-65 and ISARIC 4C mortality scores for hospitalized patients with confirmed COVID-19 infection in Saudi Arabia.
作者信息
Alwazzeh Marwan Jabr, Subbarayalu Arun Vijay, Abu Ali Batool Mohammed, Alabdulqader Reema, Alhajri Mashael, Alwarthan Sara M, AlShehail Bashayer M, Raman Vinoth, Almuhanna Fahd Abdulaziz
机构信息
Infectious Disease Division, Department of Internal Medicine, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
King Fahad Hospital of the University, Al-Khobar, Saudi Arabia.
出版信息
Inform Med Unlocked. 2023;39:101269. doi: 10.1016/j.imu.2023.101269. Epub 2023 May 9.
BACKGROUND
The COVID-19 pandemic continues with new waves that could persist with the arrival of new SARS-CoV-2 variants. Therefore, the availability of validated and effective triage tools is the cornerstone for proper clinical management. Thus, this study aimed to assess the validity of the ISARIC-4C score as a triage tool for hospitalized COVID-19 patients in Saudi Arabia and to compare its performance with the CURB-65 score.
MATERIAL AND METHODS
This retrospective observational cohort study was conducted between March 2020 and May 2021 at KFHU, Saudi Arabia, using 542 confirmed COVID-19 patient data on the variables relevant to the application of the ISARIC-4C mortality score and the CURB-65 score. Chi-square and t-tests were employed to study the significance of the CURB-65 score and the ISARIC-4C score variables considering the ICU requirements and the mortality of COVID-19 hospitalized patients. In addition, logistic regression was used to predict the variables related to COVID-19 mortality. In addition, the diagnostic accuracy of both scores was validated by calculating sensitivities, specificities, positive predictive value, negative predictive value, and Youden's J indices (YJI).
RESULTS
ROC analysis showed an AUC value of 0.834 [95% CI; 0.800-0.865]) for the CURB-65 score and 0.809 [95% CI; 0.773-0.841]) for the ISARIC-4C score. The sensitivity for CURB-65 and ISARIC-4C is 75% and 85.71%, respectively, while the specificity was 82.31% and 62.66%, respectively. The difference between AUCs was 0.025 (95% [CI; -0.0203-0.0704], p = 0.2795).
CONCLUSION
Study results support external validation of the ISARIC-4C score in predicting the mortality risk of hospitalized COVID-19 patients in Saudi Arabia. In addition, the CURB-65 and ISARIC-4C scores showed comparable performance with good consistent discrimination and are suitable for clinical utility as triage tools for hospitalized COVID-19 patients.
背景
新冠疫情仍在持续，新一波疫情可能随着新型严重急性呼吸综合征冠状病毒2（SARS-CoV-2）变体的出现而持续。因此，拥有经过验证的有效分诊工具是进行适当临床管理的基石。因此，本研究旨在评估ISARIC-4C评分作为沙特阿拉伯住院新冠患者分诊工具的有效性，并将其性能与CURB-65评分进行比较。
材料与方法
本回顾性观察性队列研究于2020年3月至2021年5月在沙特阿拉伯的法赫德国王医疗城（KFHU）进行，使用了542例确诊新冠患者的数据，这些数据涉及与应用ISARIC-4C死亡率评分和CURB-65评分相关的变量。采用卡方检验和t检验来研究CURB-65评分和ISARIC-4C评分变量在考虑新冠住院患者的重症监护病房（ICU）需求和死亡率方面的显著性。此外，使用逻辑回归来预测与新冠死亡率相关的变量。此外，通过计算敏感度、特异度、阳性预测值、阴性预测值和尤登指数（YJI）来验证这两种评分的诊断准确性。
结果
曲线下面积（ROC）分析显示，CURB-65评分的AUC值为0.834 [95%可信区间（CI）；0.800 - 0.865]），ISARIC-4C评分的AUC值为0.809 [95% CI；0.773 - 0.841]）。CURB-65和ISARIC-4C的敏感度分别为75%和85.71%，而特异度分别为82.31%和62.66%。AUC之间的差异为0.025（95% [CI；-0.0203 - 0.0704]，p = 0.2795）。
结论
研究结果支持对ISARIC-4C评分在预测沙特阿拉伯住院新冠患者死亡风险方面进行外部验证。此外，CURB-65和ISARIC-得分显示出相当的性能，具有良好的一致性鉴别能力，适合作为住院新冠患者的分诊工具用于临床。
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