Derivation of a Clinical Risk Score to Predict 14-Day Occurrence of Hypoxia, ICU Admission, and Death Among Patients with Coronavirus Disease 2019.
Derivation of a Clinical Risk Score to Predict 14-Day Occurrence of Hypoxia, ICU Admission, and Death Among Patients with Coronavirus Disease 2019.
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DOI：
10.1007/s11606-020-06353-5
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发表时间：
2021-03
影响因子：
5.7
通讯作者：
Samal L
中科院分区：
文献类型：
--
作者：
Levine DM;Lipsitz SR;Co Z;Song W;Dykes PC;Samal L
COVID-19快速发展为急性呼吸窘迫综合征的不确定性和不寻常的临床特征使得从监测环境中出院具有挑战性。预测14天缺氧发生、ICU入院和死亡的临床风险评分是不可用的。导出并验证风险评分，以预测COVID-19早期队列患者是否适合从监测环境中出院。回顾性队列的模型推导和验证。我们建立了一个手动前向逐步逻辑回归模型，以识别与排放适宜性相关的变量，并为每个变量分配点。随访至少14天后纳入无事件患者。2020年3月1日至2020年4月12日期间在美国马萨诸塞州10家医院诊断为COVID-19的所有成年患者。14天综合预测缺氧、ICU入院和死亡。我们计算了每位患者的风险评分，作为曲线下面积评估出院适宜性的预测因子。在2059例COVID-19患者中，1326例符合纳入标准。1014例患者的培训队列平均年龄为58岁，56%为女性，65%至少有一种合并症。255例（25%）患者适合出院。与出院适宜性相关的变量有年龄、血氧饱和度和白蛋白水平，风险评分在0到55之间。在切点为30时，该评分的敏感性为83%，特异性为82%。推导和验证队列的c统计量分别为0.8939 （95% CI， 0.8687至0.9192）和0.8685 （95% CI， 0.8095至0.9275）。住院病人和急诊科病人的得分相似。使用护理点数据对COVID-19患者进行3项风险评分，包括年龄、血氧饱和度和急性期反应物（白蛋白），预测出院的适宜性，并可能优化稀缺资源。在线版本包含补充材料，可在10.1007/s11606-020- 06355 -5获得。
Uncertainty surrounding COVID-19 regarding rapid progression to acute respiratory distress syndrome and unusual clinical characteristics make discharge from a monitored setting challenging. A clinical risk score to predict 14-day occurrence of hypoxia, ICU admission, and death is unavailable. Derive and validate a risk score to predict suitability for discharge from a monitored setting among an early cohort of patients with COVID-19. Model derivation and validation in a retrospective cohort. We built a manual forward stepwise logistic regression model to identify variables associated with suitability for discharge and assigned points to each variable. Event-free patients were included after at least 14 days of follow-up. All adult patients with a COVID-19 diagnosis between March 1, 2020, and April 12, 2020, in 10 hospitals in Massachusetts, USA. Fourteen-day composite predicting hypoxia, ICU admission, and death. We calculated a risk score for each patient as a predictor of suitability for discharge evaluated by area under the curve. Of 2059 patients with COVID-19, 1326 met inclusion. The 1014-patient training cohort had a mean age of 58 years, was 56% female, and 65% had at least one comorbidity. A total of 255 (25%) patients were suitable for discharge. Variables associated with suitability for discharge were age, oxygen saturation, and albumin level, yielding a risk score between 0 and 55. At a cut point of 30, the score had a sensitivity of 83% and specificity of 82%. The respective c-statistic for the derivation and validation cohorts were 0.8939 (95% CI, 0.8687 to 0.9192) and 0.8685 (95% CI, 0.8095 to 0.9275). The score performed similarly for inpatients and emergency department patients. A 3-item risk score for patients with COVID-19 consisting of age, oxygen saturation, and an acute phase reactant (albumin) using point of care data predicts suitability for discharge and may optimize scarce resources. The online version contains supplementary material available at 10.1007/s11606-020-06353-5.
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