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Vol. 68. Issue 9.
Pages 513-522 (November 2021)
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Vol. 68. Issue 9.
Pages 513-522 (November 2021)
Original article
C-Reactive protein and SOFA scale: A simple score as early predictor of critical care requirement in patients with COVID-19 pneumonia in Spain
Proteína C reactiva y escala SOFA: una simple escala como factor predictivo temprano de la necesidad de cuidados críticos en los pacientes con neumonía causada por COVID-19 en España
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L.M. Vaquero-Ronceroa, E. Sánchez-Barradoa,
Corresponding author
, D. Escobar-Maciasa, P. Arribas-Péreza, R. González de Castrob, J.R. González-Porrasc, M.V. Sánchez-Hernandeza, COVID Working Group
a Departamento de Anestesiología y Reanimación, Hospital Universitario de Salamanca-IBSAL, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
b Departamento de Anestesiología y Reanimación, Hospital Universitario de León, Universidad de León, León, Spain
c Departamento de Hematología, Hospital Universitario de Salamanca-IBSAL, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
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Tables (6)
Table 1. Baseline characteristics and COVID-19 parameters during admission.
Table 2. Laboratory parameters of COVID-19 patients during hospital admission according to ultimate destination.
Table 3. Laboratory characteristics of patients in the validation cohort, sensitivity and specificity, and cut-off points.
Table 4. AUC-ROC and cut-off point, sensitivity and specificity of COVID-19 parameters to predict the likelihood of critical care at the time of admission.
Table 5. Multiple regression using the 4 covariates of interest.
Table 6. Inflammatory profile in COVID-19 patients during admission, according to their ultimate destination.
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Additional material (1)
Abstract
Objective

To identify potential markers at admission predicting the need for critical care in patients with COVID-19 pneumonia.

Material and methods

An approved, observational, retrospective study was conducted between March 15 to April 15, 2020. 150 adult patients aged less than 75 with Charlson comorbidity index ≤6 diagnosed with COVID-19 pneumonia were included. Seventy-five patients were randomly selected from those admitted to the critical care units (critical care group [CG]) and seventy-five hospitalized patients who did not require critical care (non-critical care group [nCG]) represent the control group. One additional cohort of hospitalized patients with COVID-19 were used to validate the score.

Measurements and main results

Multivariable regression showed increasing odds of in-hospital critical care associated with increased C-reactive protein (CRP) (odds ratio 1.052 [1.009-1.101]; P = 0.0043) and higher Sequential Organ Failure Assessment (SOFA) score (1.968 [1.389–2.590]; P < 0.0001), both at the time of hospital admission. The AUC-ROC for the combined model was 0.83 (0.76-0.90) (vs AUC-ROC SOFA P < 0.05). The AUC-ROC for the validation cohort was 0.89 (0.82–0.95) (P > 0.05 vs AUC-ROC development).

Conclusion

Patients COVID-19 presenting at admission SOFA score ≥ 2 combined with CRP ≥ 9.1 mg/mL could be at high risk to require critical care.

Keywords:
COVID-19 pneumonia
Critical care
C-reactive protein
Sequential organ failure assessment - SOFA
Resumen
Objetivo

Identificar marcadores potenciales durante el ingreso que predigan la necesidad de cuidados críticos en pacientes con neumonía causada por COVID-19.

Material y métodos

Estudio autorizado, observacional y retrospectivo realizado entre el 15 de marzo y el 15 de abril de 2020; incluyó a 150 pacientes adultos menores de 75 años con índice de comorbilidad de Charlson ≤ 6 diagnosticados de neumonía por COVID-19. Se seleccionaron aleatoriamente 75 pacientes de entre los ingresados en las unidades de cuidados críticos (grupo de cuidados críticos [GC]) y 75 pacientes hospitalizados que no requirieron cuidados críticos (grupo de cuidados no críticos [GnC]) que representaron el grupo control. Se utilizó una cohorte adicional de pacientes hospitalizados con COVID-19 para validar la escala.

Medidas y resultados principales

La regresión multivariante reflejó unos incrementos de los odds ratio de cuidados críticos hospitalarios asociados al incremento de proteína C reactiva (PCR) (odds ratio: 1,052 [1,009–1,101]; p = 0,0043) y puntuaciones en Sequential Organ Failure Assessment (SOFA) más altas (1,968 [1,389–2,590]; p < 0,0001) en el momento del ingreso hospitalario. El valor de la curva AUC-ROC para el modelo combinado fue de 0,83 (0,76–0,90) (frente a AUC-ROC SOFA p < 0,05). El valor de AUC-ROC para la cohorte de validación fue de 0,89 (0,82–0,95) (p > 0,05 frente a AUC-ROC de la cohorte desarrollo).

Conclusión

Los pacientes de COVID-19 que presentan al ingreso una puntuación SOFA ≥ 2 combinada con PCR ≥ 9,1 mg/mL podrían ser de alto riesgo a la hora de requerir cuidados críticos.

Palabras clave:
Neumonía por COVID-19
Cuidados críticos
Proteína C reactiva
SOFA - evaluación de fallo orgánico secuencial

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