Erken Uyarı Skorlarının Covid 19 Pnömonisinde Ölüm Oranlarını Öngörme Yeteneği

Amaç: Acil servislerde kritik hastaların erken tanınması önemlidir. Bunun için birçok puanlama sistemi kullanılmaktadır. Bu çalışma, bu sistemlerin Covid 19 pnömonisinde prognostik değerlerini incelemiştir. Gereç ve Yöntem: Bu retrospektif çalışma Mart 2020- Mayıs 2020 tarihleri arasında yapıldı. Çalışmaya Covid 19 pnömonisi olan 212 hasta dahil edildi. Hastaların National Early Warning Score (NEWS), Modifiye Early Warning Score (MEWS) ve quick sequential organ failure assesment (qSOFA) puanları hesaplandı. Tanısal değerlerinin belirlenmesinde ROC analizi kullanıldı. Optimum eşik değerleri Youden İndeksi ile belirlendi. Bulgular: Toplam 212 hastanın 23'ü (%10.84) öldü, 34'ü (%16) yoğun bakıma alındı. MEWS, NEWS ve qSOFA'nın 65 yaş altı ölüm oranını öngörmeye yönelik eğri altında kalan alanları sırasıyla 0.852 (%95 güven aralığı 0.708-0.997), 0.882 (0.741-1.000) ve 0.879 (0.768-0.990) ve 65 yaş üstü hastalarda ise sırasıyla 0.854 (güven aralığı 0.720-0.987), 0.931(0.853-1.000), 0.776(0.609-0.944) idi. MEWS, NEWS ve qSOFA’nın yoğun bakım yatışını öngörme değerleri 65 yaş altı için sırasıyla 0.882(0.783-0.981), 0.914(0.817-1.000), 0.868(0.764-0.973) iken 65 yaş üstü hastalar için 0.845(0.725-0.965), 0.926(0.854-0.998), 0.815(0.676-0.954) idi. Ölüm oranı için optimal eşik değerleri 65 yaş altında; MEWS ≥2 (%90 duyarlılık, %74.7 özgüllük), qSOFA ≥1 (%90.9 duyarlılık, %78.1 özgüllük) iken 65 yaş üstü hastalarda NEWS ≥6 (%91.7 duyarlılık, %76.7 özgüllük) bulundu. Sonuç: Bu skorlar ölüm ve yoğun bakım yatış oranını öngörmede değerli bulunmuştur, ancak NEWS skorunun özellikle 65 yaş üstü Covid 19 pnömonisi olan hastalarda daha iyi bir gösterge olduğu görülmüştür.

Anahtar Kelimeler:

tahmin, covid 19, pnömoni, ölüm oranı

The Ability of Early Warning Scores to Predict Mortality in Covid 19 Pneumonia

Objective: Early recognition of critical patients is crucial in emergency departments. Many scoring systems are used for it. This study aim determining the prognostic values of these scoring systems for Covid 19 patients. Materials and Methods: This retrospective study was performed between March 2020 -May 2020. 212 patient who have Covid 19 pneumonia were enrolled. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS) and quick Sequential Organ Failure Assessment (qSOFA) scores were calculated according to patients’ admission data. Receiver operating characteristic (ROC) analysis was used to determine the diagnostic values of scores and the optimum cut-off values were determined by Youden Index. Results: Twenty-three (10.84%) of 212 patients died and 34 (16%) were admitted to ICU. The AUC values of MEWS, NEWS, and qSOFA for predicting mortality in < 65 years old were 0.852 (95% confidence interval 0.708-0.997), 0.882 (0.741-1.000) and 0.879 (0.768-0.990) and ≥65 years old 0.854(0.720-0.987), 0.931(0.853-1.000), 0.776(0.609-0.944) respectively. For ICU admission AUC values of MEWS, NEWS and qSOFA in <65 years old followed as; 0.882(0.783-0.981), 0.914(0.817-1.000), 0.868(0.764-0.973) and 0.845(0.725-0.965), 0.926(0.854-0.998), 0.815(0.676-0.954) in ≥ 65 years old. MEWS and qSOFA optimal cut-off values for mortality were ≥2 with 90.0% sensitivity 74.7% specificity and ≥1 with 90.9% sensitivity 78.1% specificity for <65 years, NEWS optimal cut-off is ≥6 with 91.7% sensitivity and 76.7% specificity for ≥ 65 years. Conclusion: These scores have good predictive value for mortality and ICU admission, but NEWS is better especially in ≥ 65 years old patient with Covid 19 pneumonia.

Keywords:

mortality, prediction, covid 19, pneumonia,

PDF

___

Bernheim, A., Mei, X., Huang, M., Yang, Y., Fayad, Z. A., Zhang, N., & Chung, M. (2020). Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology, 295(3),685-691. https://10.1148/radiol.2020200463.
Brabrand, M., & Henriksen, D. P. (2018). CURB-65 score is equal to NEWS for identifying mortality risk of pneumonia patients: an observational study. Lung, 196, 359-361. https://doi.org/10.1007/s00408-018-0105-y
Chatterjee, P., Nagi, N., Agarwal, A., Das, B., Banerjee, S., Sarkar, S., & Gangakhedkar, R. R. (2020). The 2019 novel coronavirus disease (COVID-19) pandemic: A review of the current evidence. The Indian journal of medical research, 151(2-3), 147.
Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., & Zhang, L. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The lancet, 395(10223), 507-513. https://doi.org/10.1016/S0140-6736(20)30211-7.
Churpek, M. M., Snyder, A., Han, X., Sokol, S., Pettit, N., Howell, M. D., & Edelson, D. P. (2017). Quick sepsis-related organ failure assessment, systemic inflammatory response syndrome, and early warning scores for detecting clinical deterioration in infected patients outside the intensive care unit. American journal of respiratory and critical care medicine, 195(7), 906-911. https://10.1164/rccm.201604-0854oc.
Covino, M., Sandroni, C., Santoro, M., Sabia, L., Simeoni, B., Bocci, M. G., ... & Franceschi, F. (2020). Predicting intensive care unit admission and death for COVID-19 patients in the emergency department using early warning scores. Resuscitation, 156, 84-91. https://10.1016/j.resuscitation.2020.08.124.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., & Levy, M. (2021). Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive care medicine, 47(11), 1181-1247. https://doi.org/10.1007/s00134-021-06506-y.
George, N., Elie-Turenne, M. C., Seethala, R. R., Baslanti, T. O., Bozorgmehri, S., Mark, K., ... & Study Investigators. (2019). External validation of the qSOFA score in emergency department patients with pneumonia. The Journal of Emergency Medicine, 57(6), 755-764. https://10.1016/j.jemermed.2019.08.043.
Holten, A. R., Nore, K. G., Tveiten, C. E. V. W. K., Olasveengen, T. M., & Tonby, K. (2020). Predicting severe COVID-19 in the Emergency Department. Resuscitation plus, 4, 100042. https://doi.org/10.1016/j.resplu.2020.100042.
Hu, H., Yao, N., & Qiu, Y. (2020). Comparing rapid scoring systems in mortality prediction of critically ill patients with novel coronavirus disease. Academic Emergency Medicine, 27(6), 461-468. doi: 10.1111/acem.13992.
Jiang, J., Yang, J., Jin, Y., Cao, J., & Lu, Y. (2018). Role of qSOFA in predicting mortality of pneumonia: a systematic review and meta-analysis. Medicine, 97(40). https://10.1097/MD.0000000000012634.
Jo, S., Jeong, T., Lee, J. B., Jin, Y., Yoon, J., & Park, B. (2016). Validation of modified early warning score using serum lactate level in community-acquired pneumonia patients. The National Early Warning Score–Lactate score. The American journal of emergency medicine, 34(3), 536-541. https://10.1016/j.ajem.2015.12.067.
Jordan, R. E., Adab, P., & Cheng, K. (2020). Covid-19: risk factors for severe disease and death. Bmj, 368. https://10.1136/bmj.m1198)
Liu, V. X., Lu, Y., Carey, K. A., Gilbert, E. R., Afshar, M., Akel, M., ... & Churpek, M. M. (2020). Comparison of early warning scoring systems for hospitalized patients with and without infection at risk for in-hospital mortality and transfer to the intensive care unit. JAMA network open, 3(5), e205191-e205191. https://10.1001/jamanetworkopen.2020.5191.
Saberian, P., Tavakoli, N., Hasani-Sharamin, P., Modabber, M., Jamshididana, M., & Baratloo, A. (2020). Accuracy of the pre-hospital triage tools (qSOFA, NEWS, and PRESEP) in predicting probable COVID-19 patients’ outcomes transferred by Emergency Medical Services. Caspian Journal of Internal Medicine, 11(Suppl 1), 536. https://10.22088/cjim.11.0.536.
Scubbe, C. P., Kruger, M., Rutherford, P., & Gemmel, L. (2001). Validation of a modified Early Warning Score in medical admissions. Qjm, 94(10), 521-526.
Smith, G. B., Prytherch, D. R., Meredith, P., Schmidt, P. E., & Featherstone, P. I. (2013). The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation, 84(4), 465-470. http:/dx.doi.org/10.1016/j.resuscitation.2012.12.016.
Tokioka, F., Okamoto, H., Yamazaki, A., Itou, A., & Ishida, T. (2018). The prognostic performance of qSOFA for community-acquired pneumonia. Journal of Intensive Care, 6, 1-8. https://10.1186/s40560-018-0307-7.
Wang, L., Lv, Q., Zhang, X., Jiang, B., Liu, E., Xiao, C., ... & Chen, L. (2020). The utility of MEWS for predicting the mortality in the elderly adults with COVID-19: a retrospective cohort study with comparison to other predictive clinical scores. PeerJ, 8, e10018. https://10.7717/peerj.10018.
World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard.2022. https://covid19.who.int/. Accessed 12 January 2022. World Health Organization. (2021). https://www.who.int/health-topics/coronavirus#tab=tab_3. Accessed 21 january 2021. Yang, X., Yu, Y., Xu, J., Shu, H., Liu, H., Wu, Y., ... & Shang, Y. (2020). Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The lancet respiratory medicine, 8(5), 475-481.
Yap, X. H., Ng, C. J., Hsu, K. H., Chien, C. Y., Goh, Z. N. L., Li, C. H., ... & Seak, C. J. (2019). Predicting need for intensive care unit admission in adult emphysematous pyelonephritis patients at emergency departments: comparison of five scoring systems. Scientific reports, 9(1), 16618. https://doi.org/10.1038/s41598-019-52989-7.
Zhang, X., Liu, B., Liu, Y., Ma, L., & Zeng, H. (2020). Efficacy of the quick sequential organ failure assessment for predicting clinical outcomes among community-acquired pneumonia patients presenting in the emergency department. BMC Infectious Diseases, 20(1), 1-8. https://10.1186/s12879-020-05044-0.