Death risk stratification in elderly patients with covid-19. A comparative cohort study in nursing homes outbreaks
Death risk stratification in elderly patients with covid-19. A comparative cohort study in nursing homes outbreaks
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DOI：
10.1016/j.archger.2020.104240
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发表时间：
2020-11-01
影响因子：
4
通讯作者：
Ollero-Baturone, M.
中科院分区：
文献类型：
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作者：
Bernabeu-Wittel, M.;Ternero-Vega, J. E.;Ollero-Baturone, M.
老年人受COVID-19影响更严重。然而，关于这一人群的具体预后评分的信息很少。主要目的是在来自四家疗养院的272名受COVID-19影响的老年患者队列中，比较最近开发的COVID-19预后评分与CURB-65、Charlson和PROFUND指数的准确性。通过校准（校准曲线和Hosmer-Lemeshov（H-L）检验）和辨别力（受试者操作曲线下面积（AUC-ROC））测量准确度。阴性和阳性预测值（NPV和PPV）也得到了。总死亡率为22.4%。在10个特定的COVID-19指数中，只有ACP和Shi等人可以评估。除CURB-65外，所有指标均显示良好的校准H-L检验，而PROFUND，ACP和CURB-65显示校准曲线的最佳结果。仅CURB-65（AUC-ROC = 0.81 [0.75-0.87]））和PROFUND（AUC-ROC = 0.67 [0.6-0.75]））显示出良好的区分能力。CURB-65（95%[90-98%]）、PROFUND（93%[77-98%]）及其组合（100%[82-100%]）获得最高NPV;而CURB-65（74%[51-88%]）及其与PROFUND的组合（80%[50-94%]）显示最高PPV。PROFUND和CURB-65指数在预测受COVID-19影响的老年患者的死亡风险方面显示出最高的准确性，而Charlson和最近开发的COVID-19特异性工具缺乏准确性，或无法进行评估。基于两个水平的综合临床分层（根据PROFUND指数计算的慢性疾病导致的基础死亡风险，加上根据CURB-65计算的COVID-19导致的当前死亡风险）可能是一种适当的方法。
Elderly people are more severely affected by COVID-19. Nevertheless scarce information about specific prognostic scores for this population is available. The main objective was to compare the accuracy of recently developed COVID-19 prognostic scores to that of CURB-65, Charlson and PROFUND indices in a cohort of 272 elderly patients from four nursing homes, affected by COVID-19. Accuracy was measured by calibration (calibration curves and Hosmer-Lemeshov (H-L) test), and discriminative power (area under the receiver operation curve (AUC-ROC). Negative and positive predictive values (NPV and PPV) were also obtained. Overall mortality rate was 22.4 %. Only ACP and Shi et al. out of 10 specific COVID-19 indices could be assessed. All indices but CURB-65 showed a good calibration by H-L test, whilst PROFUND, ACP and CURB-65 showed best results in calibration curves. Only CURB-65 (AUC-ROC = 0.81 [0.75-0.87])) and PROFUND (AUC-ROC = 0.67 [0.6-0.75])) showed good discrimination power. The highest NPV was obtained by CURB-65 (95 % [90-98%]), PROFUND (93 % [77-98%]), and their combination (100 % [82-100%]); whereas CURB-65 (74 % [51-88%]), and its combination with PROFUND (80 % [50-94%]) showed highest PPV. PROFUND and CURB-65 indices showed the highest accuracy in predicting death-risk of elderly patients affected by COVID-19, whereas Charlson and recent developed COVID-19 specific tools lacked it, or were not available to assess. A comprehensive clinical stratification on two-level basis (basal death risk due to chronic conditions by PROFUND index, plus current death risk due to COVID-19 by CURB-65), could be an appropriate approach.