Predicting of poor outcomes in COVID-19 patients: Experience from an Argentinean hospital
Predicción de malos resultados en pacientes con COVID-19: experiencia de un hospital argentino
Maximiliano Gabriel Castro, María José Sadonio, Aida Agustina Castillo Landaburo, Gisel Cuevas, Florencia Cogliano, Federico Galluccio
Abstract
Introduction: The pressure over health systems caused by the COVID-19 pandemic brought about the need to develop tools that would allow for the identification of those patients that require immediate attention. Our objective was to identify clinical and biochemical predictors of poor outcomes (PO) in a cohort of patients hospitalized due to COVID-19 in an Argentinean public hospital.
Methods: Prospective cohort study conducted from March 3rd, 2020 to February 16th, 2021 in a tertiary care center in Santa Fe, Argentina. Clinical and biochemical characteristics of patients with COVID-19 pneumonia admitted consecutively were analyzed in order to identify predictors of a composite of poor outcomes (PO) -all-cause mortality and/or need for invasive mechanical ventilation.
Results: 421 patients were included. The mean age was 56.13 ± 15.05 years. 57.0% were males. 79.7% presented at least one comorbidity. 27.7% (n=116) presented PO. In the multivariate analysis, a higher 4C-score and a higher LDH, as well as a lower SatO2/FiO2, were associated with a higher risk of PO. No variable reached an AUC of 0.800 in the ROC analysis. 4C-score presented a numerically higher AUC (0.766 IC 95% 0.715-0.817).
Conclusions: Each point that the 4C-score increases, the risk of PO rises by 28%. Also, for every 100-units increase in LDH or 50-units decrease in SatO2/FiO2 at admission, there is a 20% increased risk of PO.
Keywords
Resumen
Introducción: La presión sobre los sistemas de salud provocada por la pandemia COVID-19 generó la necesidad de desarrollar herramientas que permitan identificar a aquellos pacientes que requieren atención inmediata. Nuestro objetivo fue identificar predictores clínicos y bioquímicos de malos resultados (PO) en una cohorte de pacientes hospitalizados por COVID-19 en un hospital público argentino.
Métodos: Estudio de cohorte prospectivo realizado del 3 de marzo de 2020 al 16 de febrero de 2021 en un centro de tercer nivel de atención de Santa Fe, Argentina. Se analizaron las características clínicas y bioquímicas de los pacientes con neumonía COVID-19 ingresados consecutivamente con el fin de identificar predictores de una combinación de malos resultados (PO): mortalidad por todas las causas y / o necesidad de ventilación mecánica invasiva.
Resultados: Se incluyeron 421 pacientes. La edad media fue de 56,13 ± 15,05 años. El 57,0% eran varones. El 79,7% presentó al menos una comorbilidad. El 27,7% (n = 116) presentó PO. En el análisis multivariado, una puntuación 4C más alta y una LDH más alta, así como una SatO2 / FiO2 más baja, se asociaron con un mayor riesgo de PO. Ninguna variable alcanzó un AUC de 0,800 en el análisis ROC. La puntuación 4C presentó un AUC numéricamente superior (0,766 IC 95% 0,715-0,817).
Conclusiones: Cada punto que aumenta el puntaje 4C, el riesgo de PO aumenta en un 28%. Además, por cada 100 unidades de aumento de LDH o 50 unidades de disminución de SatO2 / FiO2 al ingreso, existe un 20% más de riesgo de PO.
Palabras clave
References
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Submitted date:
07/16/2021
Reviewed date:
08/11/2021
Accepted date:
08/28/2021
Publication date:
10/03/2021
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