A clinical risk score to identify patients with COVID-19 at high risk of critical care admission or death: An observational cohort study
A clinical risk score to identify patients with COVID-19 at high risk of critical care admission or death: An observational cohort study
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DOI：
10.1016/j.jinf.2020.05.064
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发表时间：
2020-08-01
影响因子：
28.2
通讯作者：
Cantle, Fleur
中科院分区：
文献类型：
--
作者：
Galloway, James B.;Norton, Sam;Cantle, Fleur
背景资料：新冠肺炎疫情持续升级。迫切需要对患者进行分层。了解病情恶化的风险将有助于入院和出院决策，并有助于选择临床研究，以指明治疗相关并发症的风险是合理的。方法：评估了两家伦敦医院急性入院的新冠肺炎患者和SARS-CoV-2拭子阳性患者的观察队列。从电子健康记录中收集人口统计学细节、临床数据、合并症、血液参数和胸部X线片严重程度评分。评估的终点是重症监护、入院和死亡。风险评分被用来预测结果。结果：分析了1157名患者。高龄、男性、合并症、呼吸频率、氧合、放射学严重程度、高中性粒细胞、高C反应蛋白和低白蛋白均可预测重症监护入院和死亡率。非白人种族预示着重症监护的入院，但不是死亡。社会剥夺并不能预测结果。危险评分包括12个特征：年龄40岁、男性、非白人、血氧饱和度3、中性粒细胞计数8.0×10(9)/L、C反应蛋白40 mg/L、白蛋白100 Mol/L、糖尿病、高血压和慢性肺部疾病。风险评分为4或更高对应28天内重症监护入院或死亡的累积发生率为40.7%(95%可信区间：37.1~44.4)，而得分小于4则对应12.4%(95%可信区间：8.2~16.7)。解释：我们的研究确定了新冠肺炎患者入院重症监护和死亡的预测因素。这些预测因素被合并到风险评分中，该评分将为临床护理提供信息，并对患者进行临床试验。(C)2020年英国感染协会。爱思唯尔有限公司出版。保留所有权利。
Background: The COVID-19 pandemic continues to escalate. There is urgent need to stratify patients. Understanding risk of deterioration will assist in admission and discharge decisions, and help selection for clinical studies to indicate where risk of therapy-related complications is justified.Methods: An observational cohort of patients acutely admitted to two London hospitals with COVID-19 and positive SARS-CoV-2 swab results was assessed. Demographic details, clinical data, comorbidities, blood parameters and chest radiograph severity scores were collected from electronic health records. Endpoints assessed were critical care admission and death. A risk score was developed to predict outcomes.Findings: Analyses included 1,157 patients. Older age, male sex, comorbidities, respiratory rate, oxygenation, radiographic severity, higher neutrophils, higher CRP and lower albumin at presentation predicted critical care admission and mortality. Non-white ethnicity predicted critical care admission but not death. Social deprivation was not predictive of outcome. A risk score was developed incorporating twelve characteristics: age>40, male, non-white ethnicity, oxygen saturations3, neutrophil count>8.0 x10(9)/L, CRP>40 mg/L, albumin100 mu mol/L, diabetes mellitus, hypertension and chronic lung disease. Risk scores of 4 or higher corresponded to a 28-day cumulative incidence of critical care admission or death of 40.7% (95% CI: 37.1 to 44.4), versus 12.4% (95% CI: 8.2 to 16.7) for scores less than 4.Interpretation: Our study identified predictors of critical care admission and death in people admitted to hospital with COVID-19. These predictors were incorporated into a risk score that will inform clinical care and stratify patients for clinical trials. (C) 2020 The British Infection Association. Published by Elsevier Ltd. All rights reserved.