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Trongtrakul K, Tajarernmuang P, Limsukon A, Theerakittikul T, Niyatiwatchanchai N, Surasit K, Glunriangsang P, Liwsrisakun C, Bumroongkit C, Pothirat C, Inchai J, Chaiwong W, Chanayat P, Deesomchok A. The National Early Warning Score 2 with Age and Body Mass Index (NEWS2 Plus) to Determine Patients with Severe COVID-19 Pneumonia. J Clin Med 2024; 13:298. [PMID: 38202305 PMCID: PMC10780151 DOI: 10.3390/jcm13010298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/08/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Early identification of severe coronavirus disease 2019 (COVID-19) pneumonia at the initial phase of hospitalization is very crucial. To address this, we validated and updated the National Early Warning Score 2 (NEWS2) for this purpose. (2) Methods: We conducted a study on adult patients with COVID-19 infection in Chiang Mai, Thailand, between May 2021 and October 2021. (3) Results: From a total of 725 COVID-19 adult patients, 350 (48.3%) patients suffered severe COVID-19 pneumonia. In determining severe COVID-19 pneumonia, NEWS2 and NEWS2 + Age + BMI (NEWS2 Plus) showed the C-statistic values of 0.798 (95% CI, 0.767-0.830) and 0.821 (95% CI, 0.791-0.850), respectively. The C-statistic values of NEWS2 Plus were significantly improved compared to those of NEWS2 alone (p = 0.012). Utilizing a cut-off point of five, NEWS2 Plus exhibited better sensitivity and negative predictive value than the traditional NEWS2, with values of 99.7% vs. 83.7% and 98.9% vs. 80.7%, respectively. (4) Conclusions: The incorporation of age and BMI into the traditional NEWS2 score enhanced the efficacy of determining severe COVID-19 pneumonia. Physicians can rely on NEWS2 Plus (NEWS2 + Age + BMI) as a more effective decision-making tool for triaging COVID-19 patients during early hospitalization.
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Affiliation(s)
- Konlawij Trongtrakul
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Pattraporn Tajarernmuang
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Atikun Limsukon
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Theerakorn Theerakittikul
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Nutchanok Niyatiwatchanchai
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | | | | | - Chalerm Liwsrisakun
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Chaiwat Bumroongkit
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Chaicharn Pothirat
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Juthamas Inchai
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Warawut Chaiwong
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Panida Chanayat
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Athavudh Deesomchok
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
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Chen L, Jiang T, Wang H, Hong H, Ge R, Tang H, Wang S, Xu K, Chai C, Ma Q, Jiang J. Development and validation of a risk score for predicting inconsistent condom use with women among men who have sex with men and women. BMC Public Health 2023; 23:734. [PMID: 37085861 PMCID: PMC10120174 DOI: 10.1186/s12889-023-15672-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/13/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Men who have sex with men and women (MSMW) are the most important bridge population for HIV transmission. Condom use plays an important role for HIV infection. However the predictors for condom ues with females are not well characterized. METHODS This was a cross-sectional study. Participants were enrolled by four community-based organizations (CBOs) by offline (bathrooms, bars), and online (gay applications, chat room) from April to December 2019. Electronic questionnare was fulfilled after a face-to-face training led by CBOs. We identified predictors of inconsistent condom use with females by creating a risk score based on regression coefficients. We externally validated this score via an independent cross-sectional survey conducted in Zhejiang Province in 2021. A total of 917, 615 MSMW were included in analysis in 2019 and 2021, seperately. RESULTS Among 917 MSMW, 73.2% reported heterosexual behavior in the prior 6 months and 38.3% reported inconsistent condom use with females (ICUF) over that time. Compared with heterosexual/unsure MSMW, bisexual MSMW reported more male and female sex partners, higher proportion of inconsistent condom use with males, less commercial sex with males (p < 0.05). Four risky predictors of ICUF were identified: Duration of local residence ≦6 months; more than one male partner in the prior 6 months; inconsistent condom use with males in the prior 6 months; and never heard post-exposure prophylaxis (PEP). The proportions of respondents indicating ICUF in the low- (0), medium- (2-4) and high-risk (6-20) groups (according to our risk scoring system) were 11.7% (14/120), 26.9% (96/357), and 78.1% (125/160), respectively (Ptrend < 0.001). In the validation survey, the respective proportions of those reporting ICUF were 13.4% (15/112), 17.8% (24/185) and 87.3% (96/110) (Ptrend < 0.001). CONCLUSIONS We developed and validated a predictive risk score for ICUF among MSMW; four factors were identified, of which inconsistent condom use with men was the most important. Risk reduction intervention programs should focus on MSM who report inconsistent condom use with males, never heard PEP, having multiple partners and living in local less than 6 months.
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Affiliation(s)
- Lin Chen
- Department of HIV/AIDS and STDs Control and Prevention; Department of Zhejiang Key Lab of Vaccine, Prevention and Control of Infectious Disease, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People's Republic of China
| | - Tingting Jiang
- Department of HIV/AIDS and STDs Control and Prevention; Department of Zhejiang Key Lab of Vaccine, Prevention and Control of Infectious Disease, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People's Republic of China
| | - Hui Wang
- Department of HIV/AIDS and STDs Control and Prevention; Department of Zhejiang Key Lab of Vaccine, Prevention and Control of Infectious Disease, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People's Republic of China
| | - Hang Hong
- Department of HIV/AIDS and STDs Control and Prevention, Ningbo Center for Disease Control and Prevention, Ningbo, People's Republic of China
| | - Rui Ge
- Department of HIV/AIDS and STDs Control and Prevention, Jiaxing Center for Disease Control and Prevention, Zhejiang Province, Jiaxing, People's Republic of China
| | - Huiling Tang
- Department of HIV/AIDS and STDs Control and Prevention, Jinhua Center for Disease Control and Prevention,, Jinhua, People's Republic of China
| | - Shanling Wang
- Department of HIV/AIDS and STDs Control and Prevention, Taizhou Center for Disease Control and Prevention, Taizhou, People's Republic of China
| | - Ke Xu
- Department of HIV/AIDS and STDs Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou, People's Republic of China
| | - Chengliang Chai
- Department of HIV/AIDS and STDs Control and Prevention; Department of Zhejiang Key Lab of Vaccine, Prevention and Control of Infectious Disease, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People's Republic of China
| | - Qiaoqin Ma
- Department of HIV/AIDS and STDs Control and Prevention; Department of Zhejiang Key Lab of Vaccine, Prevention and Control of Infectious Disease, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People's Republic of China
| | - Jianmin Jiang
- Department of HIV/AIDS and STDs Control and Prevention; Department of Zhejiang Key Lab of Vaccine, Prevention and Control of Infectious Disease, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People's Republic of China.
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Habibi N, Uddin S, Al‐Salameen F, Al‐Amad S, Kumar V, Al‐Otaibi M, Razzack NA, Shajan A, Shirshikar F. SARS-CoV-2, other respiratory viruses and bacteria in aerosols: Report from Kuwait's hospitals. INDOOR AIR 2021; 31:1815-1825. [PMID: 34121237 PMCID: PMC8447393 DOI: 10.1111/ina.12871] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/23/2021] [Accepted: 05/27/2021] [Indexed: 05/08/2023]
Abstract
The role of airborne particles in the spread of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is well explored. The novel coronavirus can survive in aerosol for extended periods, and its interaction with other viral communities can cause additional virulence and infectivity. This baseline study reports concentrations of SARS-CoV-2, other respiratory viruses, and pathogenic bacteria in the indoor air from three major hospitals (Sheikh Jaber, Mubarak Al-Kabeer, and Al-Amiri) in Kuwait dealing with coronavirus disease 2019 (COVID-19) patients. The indoor aerosol samples showed 12-99 copies of SARS-CoV-2 per m3 of air. Two non-SARS-coronavirus (strain HKU1 and NL63), respiratory syncytial virus (RSV), and human bocavirus, human rhinoviruses, Influenza B (FluB), and human enteroviruses were also detected in COVID-positive areas of Mubarak Al Kabeer hospital (MKH). Pathogenic bacteria such as Mycoplasma pneumonia, Streptococcus pneumonia and, Haemophilus influenza were also found in the hospital aerosols. Our results suggest that the existing interventions such as social distancing, use of masks, hand hygiene, surface sanitization, and avoidance of crowded indoor spaces are adequate to prevent the spread of SARS-CoV-2 in enclosed areas. However, increased ventilation can significantly reduce the concentration of SARS-CoV-2 in indoor aerosols. The synergistic or inhibitory effects of other respiratory pathogens in the spread, severity, and complexity of SARS-CoV-2 need further investigation.
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Affiliation(s)
- N. Habibi
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - S. Uddin
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - F. Al‐Salameen
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - S. Al‐Amad
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - V. Kumar
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - M. Al‐Otaibi
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - N. Abdul Razzack
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - A. Shajan
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - F. Shirshikar
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
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Tagliabue F, Schena D, Galassi L, Magni M, Guerrazzi G, Acerbis A, Rinallo C, Longhi D, Ronzani A, Mariani P. Modified National Early Warning Score as Early Predictor of Outcome in COVID-19 Pandemic. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:1863-1869. [PMID: 34179692 PMCID: PMC8211943 DOI: 10.1007/s42399-021-00997-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/23/2022]
Abstract
COVID-19 represented an important challenge to the Italian healthcare system (IHCS). Our main aim was to obtain evidence to support the use of modified national early warning score (m-NEWS) as an interdisciplinary, common, and universal scoring scale to quickly recognize patients with a risk of clinical deterioration before admission and during hospitalization. As a secondary goal, we tried to find a score threshold that can trigger patients' immediate medical review as a part of an optimal triaging protocol for an emergency setting where healthcare resources are overloaded. We performed a retrospective observational study. We included in our study all patients treated for COVID-19 infection in surgical departments between 01 March 2020 and 16 April 2020. Patients with negative test results for SARS-COV-2 were excluded. m-NEWS was obtained twice a day. Patients' m-NEWS were analyzed in order to verify the correlation between m-NEWS (at admission and m-NEWS variation 24 h after admission) and outcome (positive outcome-survival, negative outcome-death, or intensive care unit (ICU) transfer). We included a population-based sample of 225 SARS-COV-2-infected patients. Overall, the average age at hospitalization was 71 (ranging from 40 to 95). 144 (64%) patients were males and 81 (36%) females. m-NEWS values lower or equal to 7 were associated with the majority of the "recovered" population (100/132 75.75%) and at the same time with the minority of the "non-recovered" population (25/93 26.88%). For our sample, age is statistically correlated to the outcome but a triage protocol based solely on this variable is less effective than m-NEWS, which showed to be a reliable and easy-to-use score for first patient evaluation. Our observations pave the way towards further studies aiming at optimizing territorial and community healthcare management protocols.
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Affiliation(s)
- Fabio Tagliabue
- ASST Bergamo Est, P.O. Pesenti Fenaroli, General Surgery Unit, Alzano Lombardo, Bergamo, Italy
| | - Daniele Schena
- ASST Bergamo Est, P.O. Pesenti Fenaroli, Orthopaedics and Traumatology Unit, Alzano Lombardo, Bergamo, Italy
| | - Luca Galassi
- ASST Bergamo Est, P.O. Pesenti Fenaroli, General Surgery Unit, Alzano Lombardo, Bergamo, Italy
| | - Matteo Magni
- ASST Bergamo Est, P.O. Pesenti Fenaroli, General Surgery Unit, Alzano Lombardo, Bergamo, Italy
| | | | - Andrea Acerbis
- ASST Bergamo Est, P.O. Pesenti Fenaroli, General Surgery Unit, Alzano Lombardo, Bergamo, Italy
| | - Christina Rinallo
- ASST Bergamo Est, P.O. Pesenti Fenaroli, Orthopaedics and Traumatology Unit, Alzano Lombardo, Bergamo, Italy
| | - Daniel Longhi
- Polytechnic University of Milan, Piazza Leonardo da Vinci, 32, 20133 Milan, Italy
| | - Alberto Ronzani
- VTT Technical Research Centre of Finland Ltd., 02150 Espoo, Finland
| | - Pierpaolo Mariani
- ASST Bergamo Est, P.O. Pesenti Fenaroli, General Surgery Unit, Alzano Lombardo, Bergamo, Italy
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Predict Score: A New Biological and Clinical Tool to Help Predict Risk of Intensive Care Transfer for COVID-19 Patients. Biomedicines 2021; 9:biomedicines9050566. [PMID: 34070021 PMCID: PMC8157884 DOI: 10.3390/biomedicines9050566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The COVID-19 crisis has strained world health care systems. This study aimed to develop an innovative prediction score using clinical and biological parameters (PREDICT score) to anticipate the need of intensive care of COVID-19 patients already hospitalized in standard medical units. Methods: PREDICT score was based on a training cohort and a validation cohort retrospectively recruited in 2020 in the Marseille University Hospital. Multivariate analyses were performed, including clinical, and biological parameters, comparing a baseline group composed of COVID-19 patients exclusively treated in standard medical units to COVID-19 patients that needed intensive care during their hospitalization. Results: Independent variables included in the PREDICT score were: age, Body Mass Index, Respiratory Rate, oxygen saturation, C-reactive protein, neutrophil–lymphocyte ratio and lactate dehydrogenase. The PREDICT score was able to correctly identify more than 83% of patients that needed intensive care after at least 1 day of standard medical hospitalization. Conclusions: The PREDICT score is a powerful tool for anticipating the intensive care need for COVID-19 patients already hospitalized in a standard medical unit. It shows limitations for patients who immediately need intensive care, but it draws attention to patients who have an important risk of needing intensive care after at least one day of hospitalization.
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Cheng W, Pan A, Rathbun SL, Ge Y, Xiao Q, Martinez L, Ling F, Liu S, Wang X, Yu Z, Ebell MH, Li C, Handel A, Chen E, Shen Y. Effectiveness of neuraminidase inhibitors to prevent mortality in patients with laboratory-confirmed avian influenza A H7N9. Int J Infect Dis 2021; 103:573-578. [PMID: 33333253 DOI: 10.1016/j.ijid.2020.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Avian influenza virus A(H7N9) remains a threat to humans and has great potential to cause a pandemic in the foreseeable future. Antiviral treatment with neuraminidase inhibitors has been recommended to treat patients with H7N9 infection as early as possible, although evidence-based research on their effectiveness for H7N9 infection is lacking. METHODS Data from all laboratory-confirmed cases of H7N9 infection in Zhejiang Province between 2013 and 2017 were retrieved, and time-dependent survival models were used to evaluate the effectiveness of treatment with neuraminidase inhibitors to reduce the risk of mortality. RESULTS The final optimal model found no significant association (odds ratio 1.29, 95% confidence interval 0.78-2.15) between time to treatment with neuraminidase inhibitors and survival after controlling for age and white blood cell count. Sensitivity analyses with multiple imputation for missing data concurred with the primary analysis. CONCLUSIONS No association was found between treatment with neuraminidase inhibitors and survival in patients with H7N9 infection using various adjusted models and sensitivity analyses of missing data imputations.
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Affiliation(s)
- Wei Cheng
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - Anqi Pan
- University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics, Athens, GA, USA
| | - Stephen L Rathbun
- University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics, Athens, GA, USA
| | - Yang Ge
- University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics, Athens, GA, USA
| | - Qian Xiao
- University of Georgia, Department of Statistics, Athens, GA, USA
| | - Leonardo Martinez
- Stanford University, School of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford, CA, USA
| | - Feng Ling
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - Shelan Liu
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - Xiaoxiao Wang
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - Zhao Yu
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - Mark H Ebell
- University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics, Athens, GA, USA
| | - Changwei Li
- University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics, Athens, GA, USA; Tulane University School of Public Health and Tropical Medicine, Department of Epidemiology, New Orleans, LA, USA
| | - Andreas Handel
- University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics, Athens, GA, USA; University of Georgia, College of Public Health, Health Informatics Institute, Athens, GA, USA; University of Georgia, Center for the Ecology of Infectious Diseases, Athens, GA, USA
| | - Enfu Chen
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - Ye Shen
- University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics, Athens, GA, USA.
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Covino M, Sandroni C, Santoro M, Sabia L, Simeoni B, Bocci MG, Ojetti V, Candelli M, Antonelli M, Gasbarrini A, Franceschi F. Predicting intensive care unit admission and death for COVID-19 patients in the emergency department using early warning scores. Resuscitation 2020; 156:84-91. [PMID: 32918985 PMCID: PMC7480278 DOI: 10.1016/j.resuscitation.2020.08.124] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/13/2020] [Accepted: 08/26/2020] [Indexed: 02/08/2023]
Abstract
AIMS To identify the most accurate early warning score (EWS) for predicting an adverse outcome in COVID-19 patients admitted to the emergency department (ED). METHODS In adult consecutive patients admitted (March 1-April 15, 2020) to the ED of a major referral centre for COVID-19, we retrospectively calculated NEWS, NEWS2, NEWS-C, MEWS, qSOFA, and REMS from physiological variables measured on arrival. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and the area under the receiver operating characteristic (AUROC) curve of each EWS for predicting admission to the intensive care unit (ICU) and death at 48 h and 7 days were calculated. RESULTS We included 334 patients (119 [35.6%] females, median age 66 [54-78] years). At 7 days, the rates of ICU admission and death were 56/334 (17%) and 26/334 (7.8%), respectively. NEWS was the most accurate predictor of ICU admission within 7 days (AUROC 0.783 [95% CI, 0.735-0.826]; sensitivity 71.4 [57.8-82.7]%; NPV 93.1 [89.8-95.3]%), while REMS was the most accurate predictor of death within 7 days (AUROC 0.823 [0.778-0.863]; sensitivity 96.1 [80.4-99.9]%; NPV 99.4[96.2-99.9]%). Similar results were observed for ICU admission and death at 48 h. NEWS and REMS were as accurate as the triage system used in our ED. MEWS and qSOFA had the lowest overall accuracy for both outcomes. CONCLUSION In our single-centre cohort of COVID-19 patients, NEWS and REMS measured on ED arrival were the most sensitive predictors of 7-day ICU admission or death. EWS could be useful to identify patients with low risk of clinical deterioration.
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Affiliation(s)
- Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Michele Santoro
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luca Sabia
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Benedetta Simeoni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Maria Grazia Bocci
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Veronica Ojetti
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Marcello Candelli
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Massimo Antonelli
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Institute of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Institute of Emergency Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
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8
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Liu J, Liu S. The management of coronavirus disease 2019 (COVID-19). J Med Virol 2020; 92:1484-1490. [PMID: 32369222 PMCID: PMC7267323 DOI: 10.1002/jmv.25965] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 02/06/2023]
Abstract
In December 2019, a novel coronavirus causing severe acute respiratory disease occurred in Wuhan, China. It is an emerging infectious disease with widespread and rapid infectiousness. The World Health Organization declared the coronavirus outbreak to be a public health emergency of international concern on 31 January 2020. Severe COVID-19 patients should be managed and treated in a critical care unit. Performing a chest X-ray/CT can judge the severity of the disease. The management of COVID-19 patients includes epidemiological risk and patient isolation; treatment entails general supportive care, respiratory support, symptomatic treatment, nutritional support, psychological intervention, etc. The prognosis of the patients depends upon the severity of the disease, the patient's age, the underlying diseases of the patients, and the patient's overall medical condition. The management of COVID-19 should focus on early diagnosis, immediate isolation, general and optimized supportive care, and infection prevention and control.
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Affiliation(s)
- Jialin Liu
- Department of Otolaryngology, West China HospitalSichuan UniversitySichuanChina
- Department of Medical InformaticsWest China Medical SchoolSichuanChina
| | - Siru Liu
- Department of Biomedical InformaticsUniversity of UtahSalt LakeUtah
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9
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Song X, Liu X, Wang C. The role of telemedicine during the COVID-19 epidemic in China-experience from Shandong province. Crit Care 2020; 24:178. [PMID: 32345359 PMCID: PMC7187668 DOI: 10.1186/s13054-020-02884-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Xuan Song
- ICU, Liaocheng Cardiac Hospital Affiliated to Shandong First Medical University, Liaocheng, Shandong, China.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,ICU, DongE Hospital Affiliated to Shandong First Medical University, Liaocheng, Shandong, China
| | - Xinyan Liu
- ICU, Liaocheng Cardiac Hospital Affiliated to Shandong First Medical University, Liaocheng, Shandong, China.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,ICU, DongE Hospital Affiliated to Shandong First Medical University, Liaocheng, Shandong, China
| | - Chunting Wang
- ICU, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 16766 Jingshi Road, Jinan, 250014, Shandong, China.
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10
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Liao X, Wang B, Kang Y. Novel coronavirus infection during the 2019-2020 epidemic: preparing intensive care units-the experience in Sichuan Province, China. Intensive Care Med 2020; 46:357-360. [PMID: 32025779 PMCID: PMC7042184 DOI: 10.1007/s00134-020-05954-2] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Xuelian Liao
- Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Bo Wang
- Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yan Kang
- Sichuan University West China Hospital, Chengdu, Sichuan, China.
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