Derivation and Validation of a Predictive Score for Disease Worsening in Patients with COVID-19

被引:28
作者
Gerotziafas, Grigoris T. [1 ,2 ]
Sergentanis, Theodoros N. [3 ]
Voiriot, Guillaume [4 ]
Lassel, Ludovic [5 ]
Papageorgiou, Chryssa [6 ]
Elabbadi, Alexandre [4 ]
Turpin, Matthieu [4 ]
Vandreden, Patrick [7 ]
Papageorgiou, Loula [1 ,2 ]
Psaltopoulou, Theodora [3 ]
Terpos, Evangelos [3 ]
Dimopoulos, Meletios-Athanasios [3 ]
Parrot, Antoine [8 ]
Cadranel, Jacques [8 ]
Pialoux, Gilles [5 ]
Fartoukh, Muriel [4 ]
Elalamy, Ismail [1 ,2 ]
机构
[1] Sorbonne Univ, Inst Univ Cancerol, Fac Med, INSERM U938,Ctr Rech St Antoine,Res Grp Canc Haem, Paris, France
[2] Sorbonne Univ, Hop Tenon, Hop Univ Est Parisien, AP HP,Fac Med,Serv Hematol Biol, Paris, France
[3] Natl & Kapodistrian Univ Athens, Sch Med, Dept Clin Therapeut, Athens, Greece
[4] Sorbonne Univ, Hop Tenon, AP HP, Serv Med Intens Reanimat, Paris, France
[5] Sorbonne Univ, Hop Tenon, Hop Univ Est Parisien, AP HP,Serv Malad Infect & Trop,Fac Med, Paris, France
[6] Sorbonne Univ, Hop Univ Est Parisien, Hop Tenon, AP HP,Fac Med,Serv Anesthesie Reanimat & Med Peri, Paris, France
[7] Diagnost Stago, Clin Res Dept, Gennevilliers, France
[8] Sorbonne Univ, Hop Univ Est Parisien, Hop Tenon, AP HP,Fac Med,Serv Pneumol, Paris, France
关键词
COVID-19; SARS-CoV-2; disseminated intravascular coagulation; antithrombin; D-dimers; MANAGEMENT;
D O I
10.1055/s-0040-1716544
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The prospective observational cohort study COMPASS-COVID-19 aimed to develop a risk assessment model for early identification of hospitalized COVID-19 patients at risk for worsening disease. Patients with confirmed COVID-19 ( n =430) hospitalized between March 18 and April 21, 2020 were divided in derivation ( n =310) and validation ( n =120) cohorts. Two groups became evident: (1) good prognosis group (G-group) with patients hospitalized at the conventional COVID-19 ward and (2) Worsening disease group (W-group) with patients admitted to the intensive care unit (ICU) from the emergency departments. The study end point was disease worsening (acute respiratory failure, shock, myocardial dysfunction, bacterial or viral coinfections, and acute kidney injury) requiring ICU admission. All patients were routinely evaluated for full blood count, prothrombin time, fibrinogen, D-dimers, antithrombin (AT), and protein C activity. Data from the first hospitalization day at the conventional ward or the ICU were analyzed. Cardiovascular risk factors and comorbidities were routinely registered. Obesity, hypertension, diabetes and male gender, increased fibrinogen and D-dimers, thrombocytopenia, AT deficiency, lymphopenia, and an International Society on Thrombosis and Haemostasis (ISTH) score for compensated disseminated intravascular coagulation score (cDIC-ISTH) >= 5 were significant risk factors for worsening disease. The COMPASS-COVID-19 score was derived from multivariate analyses and includes obesity, gender, hemoglobin, lymphocyte, and the cDIC-ISTH score (including platelet count, prothrombin time, D-dimers, AT, and protein C levels). The score has a very good discriminating capacity to stratify patients at high and low risk for worsening disease, with an area under the receiver operating characteristic curve value of 0.77, a sensitivity of 81%, and a specificity of 60%. Application of the COMPASS-COVID-19 score at the validation cohort showed 96% sensitivity. The COMPASS-COVID-19 score is an accurate clinical decision-making tool for an easy identification of COVID-19 patients being at high risk for disease worsening.
引用
收藏
页码:1680 / 1690
页数:11
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