Development of a multivariate prediction model of intensive care unit transfer or death: A French prospective cohort study of hospitalized COVID-19 patients.
Development of a multivariate prediction model of intensive care unit transfer or death: A French prospective cohort study of hospitalized COVID-19 patients.
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DOI：
10.1371/journal.pone.0240711
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
DIMICOVID
中科院分区：
文献类型：
--
作者：
Allenbach Y;Saadoun D;Maalouf G;Vieira M;Hellio A;Boddaert J;Gros H;Salem JE;Resche Rigon M;Menyssa C;Biard L;Benveniste O;Cacoub P;DIMICOVID
欧洲人群中2019冠状病毒病（COVID-19）患者的预后因素缺乏。我们的目标是确定入院时的早期预后因素，以优化在内科病房住院的COVID-19患者的管理。这项法国单中心前瞻性队列研究评估了152例严重急性呼吸综合征冠状病毒2型实时逆转录酶-聚合酶链反应检测阳性的患者，这些患者在法国巴黎的Pitié-Salpêtrière医院（一家三级护理大学医院）的内科和临床免疫科住院。在多变量logistic回归模型中评价了第14天（D14）重症监护室（ICU）转移或死亡、第14天（D14）存活出院和重度状态（保持通气或死亡）的预测因素;评估了模型的性能，包括区分和校准（C指数、校准曲线、R2、Brier评分）。对在巴黎附近的一家法国医院住院的132名患者的外部样本进行了验证。ICU转移或死亡的概率为32%（47/147）（95% CI 25-40）。年龄较大（OR 2.61，95% CI 0.96-7.10），呼吸功能较差（世界卫生组织（WHO）临床量表每增加1分，OR 4.04，95% CI 1.76-9.25），CRP水平较高（OR 1.63/100 mg/L增量，95%CI 0.98-2.71）和淋巴细胞计数降低（OR 0.36/1000/mm 3增量，95%CI 0.13-0.99）与ICU需求或死亡风险增加相关。9分顺序量表评分系统定义了低（评分0-2）、中度（评分3-5）和高（评分6-8）风险患者，预测第14天ICU转移或死亡的风险分别为2%、25%和81%。因此，在这项针对在法国内科病房住院的实验室确诊的COVID-19患者的前瞻性队列研究中，入院时的简化评分系统预测了D14的结局。
Prognostic factors of coronavirus disease 2019 (COVID-19) patients among European population are lacking. Our objective was to identify early prognostic factors upon admission to optimize the management of COVID-19 patients hospitalized in a medical ward. This French single-center prospective cohort study evaluated 152 patients with positive severe acute respiratory syndrome coronavirus 2 real-time reverse transcriptase–polymerase chain reaction assay, hospitalized in the Internal Medicine and Clinical Immunology Department, at Pitié-Salpêtrière’s Hospital, in Paris, France, a tertiary care university hospital. Predictive factors of intensive care unit (ICU) transfer or death at day 14 (D14), of being discharge alive and severe status at D14 (remaining with ventilation, or death) were evaluated in multivariable logistic regression models; models’ performances, including discrimination and calibration, were assessed (C-index, calibration curve, R2, Brier score). A validation was performed on an external sample of 132 patients hospitalized in a French hospital close to Paris, in Aulnay-sous-Bois, Île-de-France. The probability of ICU transfer or death was 32% (47/147) (95% CI 25–40). Older age (OR 2.61, 95% CI 0.96–7.10), poorer respiratory presentation (OR 4.04 per 1-point increment on World Health Organization (WHO) clinical scale, 95% CI 1.76–9.25), higher CRP-level (OR 1.63 per 100mg/L increment, 95% CI 0.98–2.71) and lower lymphocytes count (OR 0.36 per 1000/mm3 increment, 95% CI 0.13–0.99) were associated with an increased risk of ICU requirement or death. A 9-point ordinal scale scoring system defined low (score 0–2), moderate (score 3–5), and high (score 6–8) risk patients, with predicted respectively 2%, 25% and 81% risk of ICU transfer or death at D14. Therefore, in this prospective cohort study of laboratory-confirmed COVID-19 patients hospitalized in a medical ward in France, a simplified scoring system at admission predicted the outcome at D14.
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