Association of Padua prediction score with in-hospital prognosis in COVID-19 patients
Association of Padua prediction score with in-hospital prognosis in COVID-19 patients
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DOI：
10.1093/qjmed/hcaa224
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发表时间：
2020-11-01
影响因子：
13.3
通讯作者：
Xu, L.
中科院分区：
文献类型：
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作者：
Zeng, D. X.;Xu, J. L.;Xu, L.
背景：近20%的新型冠状病毒病（COVID-19）患者存在凝血功能异常。Padua预测评分（PPS）是一种经验证的静脉血栓栓塞（VTE）风险评估工具。然而，其在COVID-19患者评估中的临床价值尚不清楚。方法：我们使用PPS前瞻性评估COVID-19患者的VTE风险。收集人口统计学和临床数据。结果：共纳入274例患者，总死亡率为17.2%。与低PPS组相比，高PPS组患者的白细胞介素6水平（25.27 vs.2.55pg/ml，P < 0.001）、预防性抗凝率（60.7% vs.6.5%，P < 0.001）和病死率（40.5% vs.5.9%，P < 0.001）明显增高，且凝血功能明显异常。危重患者的PPS评分高于重症患者（6分比2分，P < 0.001）。多因素Logistic回归分析显示，高PPS（OR：7.35，95%CI：3.08-16.01）、白细胞介素-6升高（OR：11.79，95%CI：5.45-26.20）和D-二聚体升高（OR：4.65，95%CI：1.15-12.15）是院内死亡的独立危险因素。Kaplan-Meier分析显示PPS较高的患者具有显著的生存劣势。PPS较高的患者预防性抗凝治疗的死亡率略有优势，但无统计学意义（37.1%vs.45.7%，P = 0.42）。结论：PPS较高的患者院内预后较差。在PPS较高的COVID-19患者中，预防性抗凝显示出轻微的死亡率优势，但仍需进一步研究。
Background: Nearly 20% novel coronavirus disease 2019 (COVID-19) patients have abnormal coagulation function. Padua prediction score (PPS) is a validated tools for venous thromboembolism (VTE) risk assessment. However, its clinical value in COVID-19 patients' evaluation was unclear.Methods: We prospectively evaluated the VTE risk of COVID-19 patients using PPS. Demographic and clinical data were collected. Association of PPS with 28-day mortality was analyzed by multivariate logistic regression and Kaplan-Meier analysis.Results: Two hundred and seventy-four continuous patients were enrolled, with total mortality of 17.2%. Patients in high PPS group, with significantly abnormal coagulation, have a higher levels of interleukin 6 (25.27 vs. 2.55 pg/ml, P < 0.001), prophylactic anticoagulation rate (60.7% vs. 6.5%, P < 0.001) and mortality (40.5% vs. 5.9%, P < 0.001) when compared with that in low PPS group. Critical patients showed higher PPS (6 vs. 2 score, P < 0.001) than that in severe patients. Multivariate logistic regression revealed the independent risk factors of in-hospital mortality included high PPS [odds ratio (OR): 7.35, 95% confidence interval (CI): 3.08-16.01], increased interleukin-6 (OR: 11.79, 95% CI: 5.45-26.20) and elevated d-dimer (OR: 4.65, 95% CI: 1.15-12.15). Kaplan-Meier analysis indicated patients with higher PPS had a significant survival disadvantage. Prophylactic anticoagulation in higher PPS patients shows a mild advantage of mortality but without statistical significance (37.1% vs. 45.7%, P = 0.42).Conclusion: Higher PPS associated with in-hospital poor prognosis in COVID-19 patients. Prophylactic anticoagulation showed a mild advantage of mortality in COVID-19 patients with higher PPS, but it remain to need further investigation.