Acceso usuarios
Héctor Alonso Valle 
, Enrique Peraita Fernández, Óscar Miró Andreu, Mar Ortega Romero, Sonia Jiménez Hernández, Leticia Fresco, María Luisa López Grima, María Ángeles Juan Gómez, Begoña Espinosa, Manuel Salido Mota, Julio Bolanos Guedes, Enrique Martín Mojarro, Josep Tost, María Pilar López Díez, Rosa Sorando Serra, María Jose Cano Cano, José María Ferreras, Belén Arribas Entrala, Rocío Moyano García, Fahd Beddar Chaib, Lluís Llauger, M.Á. de las Nieves López, Mihai Podaru, Salvador Pereira Sanz, Lourdes Hernández Castells, Sara Laínez Martínez, Juan González del Castillo
OBJETIVO. Evaluar dos escalas específicas para la enfermedad por coronavirus (COVID-19) comparándolas con escalas de gravedad global y de neumonía adquirida en la comunidad.
MÉTODOS. Estudio retrospectivo de pacientes diagnosticados en urgencias de neumonía y test positivo para COVID-19 desde el 1 de marzo al 30 de abril de 2020 con las siguientes variables de estudio: edad, sexo, escala PREDICOVID, escala CLINIC, escala NEWS, escala qSOFA y las escalas Fine y CURB 65. Se registró la necesidad de ingreso en la unidad de cuidados intensivos (UCI) y la mortalidad tanto intrahospitalaria como a los 30 días, con cálculo de curvas ROC para mortalidad.
RESULTADOS. Se analizaron 3.494 pacientes, con una edad media de 67,9 ± 17 años. 2.660 (76%) de los pacientes ingresaron en el hospital y 839 (27%) en la UCI del hospital. Fallecieron intrahospitalariamente 630 pacientes (18,4%). Las puntuaciones en la escala PREDICOVID en el 1.er-3.er quintil mostraron una mortalidad menor de forma estadísticamente significativa intrahospitalaria (10,8% vs 38,1%; p < 0,001).Puntuaciones en la escala CLINIC de riesgo bajo-intermedio mostraron mortalidad menor de forma estadísticamente significativa (12,8 vs 85,7%; p < 0,001). El valor obtenido al analizar la curva ROC para la mortalidad en las distintas escalas fue el siguiente: Escala Fine 0,69 (IC 0,41-0,96), Escala PREDICOVID 0,65 (IC 0,30-0,99), Escala CLINIC 063 (IC 0,25-1,00), Escala CURB-65 0,62 (IC 0,26-0,96), Escaña News 0,58 (IC 0,23-0,94), Escala q-SOFA 0,38 (IC 0,36-0,73).
CONCLUSIONES. El comportamiento de las 6 escalas fue favorable a la hora de predecir la mortalidad, siendo la escala Fine la que presentaba una mejor capacidad predictiva.
OBJECTIVE. To evaluate 2 scales for COVID-19 pneumonia severity and compare them to scales used to assess severity in general and community-acquired pneumonia.
METHODS. Retrospective study of patients diagnosed with pneumonia in the emergency department and who tested positive for COVID-19 between March 1 and April 30, 2020. In addition to recording age and sex, we calculated scores with the 2 specific tools (PREDICOVID and CLINIC) as well as the National Early Warning Score (NEWS), the Quick Sequential Organ Failure Assessment (qSOFA), the Pneumonia Severity Index (PSI), and the CURB 65 score (for confusion, blood urea nitrogen level, respiratory rate, and systolic blood pressure). Outcomes recorded were hospitalization, admission to an intensive care unit (ICU), in-hospital mortality, and 30-day mortality. The area under the receiver operating characteristic curve (AUC) was calculated to assess each score’s ability to predict mortality.
RESULTS. We analyzed data for 3499 patients. The mean (SD) age of patients included was 67.9 (17) years; 2660 of the patients (76%) were hospitalized, and 839 (27%) were admitted to the ICU. There were 630 in-hospital deaths (18.4%). Patients with PREDICOVID scores in the first to third quintiles had significantly lower in-hospital mortality (10.8% vs 38.1% in higher quintiles, P < .001). Patients with CLINIC scores indicating low to intermediate risk also had significantly lower in-hospital mortality (12.8% vs 85.7%, P < .001). The AUC values and 95% CIs for the scales as predictors of mortality were as follows: PSI, 0.69 (0.41-0.96); PREDICOVID, 0.65 (0.30-0.99); CLINIC, 0.63 (0.25-1.00), CURB-65, 0.62 (0.26-0.96); NEWS, 0.58 (0.23-0.94); and qSOFA, 0.38 (0.36-0.73).
CONCLUSIONS. All 6 scales were able to predict mortality. The PSI had the greatest predictive capacity
