评估急诊科中PIRO评分对COVID-19结局的六种临床预测评分的预测性能。

Evaluating the predictive performance of PIRO score against six clinical prediction scores for COVID-19 outcomes in the emergency department.

作者信息

Geng Nan, Wu Zhipeng, Lai Chunlian, Cui Yingying, Miao Yixin, Li Mengyun, Wang Bojun, Shi Hongbo, Ma Yingmin, Liu Bo

机构信息

Department of Emergency Medicine, Beijing Youan Hospital, Capital Medical University, No. 8, Xi Tou Tiao, Youanmenwai Street, Fengtai District, Beijing, 100069, People's Republic of China.

Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, No. 8, Xi Tou Tiao, Youanmenwai Street, Fengtai District, Beijing, 100069, People's Republic of China.

出版信息

Sci Rep. 2025 Jul 29;15(1):27657. doi: 10.1038/s41598-025-13131-y.

DOI:10.1038/s41598-025-13131-y

PMID:40731068

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12307896/

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has led to the development of numerous prognostic models for patient assessment. However, the potential utility of the predisposition, insult/infection, response, organ dysfunction (PIRO) score in evaluating COVID-19 severity and outcomes remains unexplored, presenting a gap in current research. A retrospective analysis was conducted on a cohort of 374 individuals diagnosed with COVID-19 who were admitted to the emergency department of Beijing Youan Hospital. Demographic data, treatment regimens, and seven prognostic scoring systems, including PIRO, were evaluated. To evaluate the models' prognostic accuracy for 28-day mortality, area under the receiver operating characteristic (AUROC) analysis was employed. Comparative performance between scoring systems was quantified using the DeLong method for paired ROC curves. Of the 374 patients meeting inclusion criteria, 120 (32.1%) died within 28 day of hospitalization. Significant disparities were observed between survivors and non-survivors regarding age, laboratory parameters, and clinical scores. Analysis of patient distribution and mortality rates across different score ranges revealed a positive correlation between score magnitude and 28-day mortality. The PIRO score demonstrated superior prognostic capability, yielding an AUC of 0.898 (95% CI 0.866-0.929). The quick sequential organ failure assessment (qSOFA) score followed closely (AUC 0.882, 95% CI 0.849-0.914). Both critical illness risk score (COVID-GRAM) and national early warning score 2 (NEWS2) exhibited AUCs exceeding 0.85 (COVID-GRAM 0.854, 95% CI 0.812-0.895; NEWS2: 0.851, 95% CI 0.813-0.889). DeLong test analysis revealed statistically significant differences in AUC between PIRO and confusion, urea, respiration, systolic pressure, age ≥ 65 (CURB-65), pneumonia severity index (PSI), COVID-GRAM, rapid acute physiology score (RAPS), and NEWS2 (all p < 0.05). Analysis revealed the PIRO scoring system as a robust predictor of 28-day mortality among COVID-19 cases presenting to the emergency setting, offering potential refinement of risk stratification and clinical management strategies.

摘要

2019年冠状病毒病（COVID-19）大流行促使人们开发了众多用于评估患者的预后模型。然而，易感性、损伤/感染、反应、器官功能障碍（PIRO）评分在评估COVID-19严重程度和预后方面的潜在效用仍未得到探索，这是当前研究中的一个空白。对北京佑安医院急诊科收治的374例确诊为COVID-19的患者进行了回顾性分析。评估了人口统计学数据、治疗方案以及包括PIRO在内的七种预后评分系统。为评估这些模型对28天死亡率的预后准确性，采用了受试者操作特征曲线下面积（AUROC）分析。使用配对ROC曲线的DeLong方法对评分系统之间的比较性能进行了量化。在符合纳入标准的374例患者中，120例（32.1%）在住院28天内死亡。在幸存者和非幸存者之间，在年龄、实验室参数和临床评分方面观察到显著差异。对不同评分范围的患者分布和死亡率进行分析，结果显示评分高低与28天死亡率之间呈正相关。PIRO评分显示出卓越的预后能力，曲线下面积为0.898（95%可信区间0.866 - 0.929）。快速序贯器官衰竭评估（qSOFA）评分紧随其后（曲线下面积为0.882，95%可信区间0.849 - 0.914）。危重病风险评分（COVID-GRAM）和国家早期预警评分2（NEWS2）的曲线下面积均超过0.85（COVID-GRAM为0.854，95%可信区间0.812 - 0.895；NEWS2为0.851，95%可信区间0.813 - 0.889）。DeLong检验分析显示，PIRO与意识模糊、尿素、呼吸、收缩压、年龄≥65岁（CURB-65）、肺炎严重程度指数（PSI）、COVID-GRAM、快速急性生理学评分（RAPS）和NEWS2之间的曲线下面积存在统计学显著差异（所有p < 0.05）。分析表明，PIRO评分系统是急诊科COVID-19病例28天死亡率的有力预测指标，可为风险分层和临床管理策略提供潜在的优化。