A fuller picture of COVID-19 prognosis: the added value of vulnerability measures to predict mortality in hospitalised older adults
A fuller picture of COVID-19 prognosis: the added value of vulnerability measures to predict mortality in hospitalised older adults
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DOI：
10.1093/ageing/afaa240
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发表时间：
2021-01-01
期刊：
影响因子：
6.7
通讯作者：
Avelino-Silva, Thiago J.
中科院分区：
文献类型：
--
作者：
Romero Aliberti, Marlon Juliano;Covinsky, Kenneth E.;Avelino-Silva, Thiago J.
工作背景：虽然2019年冠状病毒病（COVID-19）严重影响老年人，在急性护理环境中使用传统的分诊工具忽略了脆弱性的关键方面。目的：本研究旨在确定在疾病急性工具中添加快速脆弱性筛查以预测住院COVID-19患者死亡率的有用性。设计：队列研究。设置：致力于提供COVID-19护理的大型大学医院。参与者：参与者包括1，428名年龄≥ 50岁的连续住院患者。方法：使用修改后的PRO-AGE评分评估脆弱性（0-7;更高=更差），这是一种经过验证且易于管理的工具，可对身体损伤、近期住院、急性精神变化、体重减轻和疲劳进行评级。基线协变量包括年龄、性别、Charlson合并症评分和国家早期预警评分（NEWS），一种众所周知的疾病急性工具。我们的结果是60天内的死亡时间admission.Results：患者的中位年龄为66岁，58%是男性。在改良PRO-AGE的四分位数中，60天死亡率的发生率范围为22%至69%。在校正分析中，与改良PRO-AGE评分0-1（“最低四分位数”）相比，改良PRO-AGE评分2-3、4和5-7的60天死亡率的风险比（95%置信区间）分别为1.4（1.1-1.9）、2.0（1.5-2.7）和2.8（2.1-3.8）。修改后的PRO-AGE预测不同的死亡风险水平内的每个层次的NEWS和提高的歧视死亡率预测models.Conclusions的结论：增加疾病的敏感性提高了预测住院COVID-19患者的死亡率的准确性。结合PRO-AGE和NEWS等工具可能有助于对COVID-19的死亡风险进行分层。
Background: Although coronavirus disease 2019 (COVID-19) disproportionally affects older adults, the use of conventional triage tools in acute care settings ignores the key aspects of vulnerability.Objective: This study aimed to determine the usefulness of adding a rapid vulnerability screening to an illness acuity tool to predict mortality in hospitalised COVID-19 patients.Design: Cohort study.Setting: Large university hospital dedicated to providing COVID-19 care.Participants: Participants included are 1,428 consecutive inpatients aged =50 years.Methods: Vulnerability was assessed using the modified version of PRO-AGE score (0-7; higher = worse), a validated and easy-to-administer tool that rates physical impairment, recent hospitalisation, acute mental change, weight loss and fatigue. The baseline covariates included age, sex, Charlson comorbidity score and the National Early Warning Score (NEWS), a well-known illness acuity tool. Our outcome was time-to-death within 60 days of admission.Results: The patients had a median age of 66 years, and 58% were male. The incidence of 60-day mortality ranged from 22% to 69% across the quartiles of modified PRO-AGE. In adjusted analysis, compared with modified PRO-AGE scores 0-1 ('lowest quartile'), the hazard ratios (95% confidence interval) for 60-day mortality for modified PRO-AGE scores 2-3, 4 and 5-7 were 1.4 (1.1-1.9), 2.0 (1.5-2.7) and 2.8 (2.1-3.8), respectively. The modified PRO-AGE predicted different mortality risk levels within each stratum of NEWS and improved the discrimination of mortality prediction models.Conclusions: Adding vulnerability to illness acuity improved accuracy of predicting mortality in hospitalised COVID-19 patients. Combining tools such as PRO-AGE and NEWS may help stratify the risk of mortality from COVID-19.