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[新型冠状病毒肺炎病毒肺炎患者院内死亡的预后量表]

[Prognostic scale for in-hospital mortality in patients with COVID-19 viral pneumonia].

作者信息

Molina-Pérez Carlos José, Berumen-Lechuga María Guadalupe, Leaños-Miranda Alfredo, Sánchez-Mejía Eduardo Rafael, Gasca-Martínez Víctor, Fernández-Méndez Jacqueline

机构信息

Instituto Mexicano del Seguro Social, Hospital General de Zona No. 252, Servicio de Urgencias. Atlacomulco, Estado de México, México.

Instituto Mexicano del Seguro Social, Órgano de Operación Administrativa Desconcentrada México Poniente, Jefatura de Servicios de Prestaciones Médicas. Toluca, Estado de México, México.

出版信息

Rev Med Inst Mex Seguro Soc. 2023 Jul 31;61(4):474-481. doi: 10.5281/zenodo.8200380.

Abstract

BACKGROUND

The COVID-19 pandemic represented a challenge in medical care. A tool would be very useful to establish the prognosis of in-hospital death that is reliable and can be applied to the Mexican population entitled to the IMSS.

OBJECTIVE

To propose a prognostic scale to stratify patients with viral pneumonia COVID-19 in the emergency services.

MATERIAL AND METHODS

A nested case-control study was conducted in a cohort of patients who were consecutively admitted to the emergency department with viral pneumonia COVID-19. The cases were those patients who died, and the controls were those who were discharged due to health improvement. An association analysis was performed between the variables with significant differences between groups. Subsequently, the association was adjusted using a multivariate logistic regression model, from which the prognostic scale was developed.

RESULTS

A total of 70 subjects with COVID-19 were included, 34 cases and 36 controls. Chronic diseases, smoking, severe pulmonary involvement diagnosed by tomography, leukocytosis, and pulse oximetry less than 80% with were associated with in-hospital mortality; Odds Ratio (OR) of >1.1. Vaccination was a protective factor (OR = 0.04, CI95%: 0.01-0.16). A score greater than 3 points on the prognostic scale predicts in-hospital mortality with a specificity of 0.86 and a sensitivity of 0.73.

CONCLUSIONS

The proposed prognostic scale can be a useful tool in the classification of patients with COVID-19 viral pneumonia in the emergency room services of secondary care level Hospitals.

摘要

背景

2019年冠状病毒病(COVID-19)大流行对医疗护理构成了挑战。一种有助于确定可靠的院内死亡预后且可应用于墨西哥社会保障局(IMSS)参保人群的工具将非常有用。

目的

提出一种预后量表,用于对急诊服务中的COVID-19病毒性肺炎患者进行分层。

材料与方法

对一组因COVID-19病毒性肺炎连续入住急诊科的患者进行了一项巢式病例对照研究。病例为死亡患者,对照为因病情好转而出院的患者。对组间有显著差异的变量进行了关联分析。随后,使用多变量逻辑回归模型对关联进行调整,由此制定了预后量表。

结果

共纳入70例COVID-19患者,34例病例和36例对照。慢性病、吸烟、通过断层扫描诊断的严重肺部受累、白细胞增多症以及脉搏血氧饱和度低于80%与院内死亡率相关;比值比(OR)>1.1。接种疫苗是一个保护因素(OR = 0.04,95%置信区间:0.01 - 0.16)。预后量表得分大于3分可预测院内死亡率,特异性为0.86,敏感性为0.73。

结论

所提出的预后量表可作为二级护理水平医院急诊服务中COVID-19病毒性肺炎患者分类的有用工具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8596/10484551/bc837995cd57/04435117-61-4-474-f001.jpg

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