Stratifying Deterioration Risk by Acuity at Admission Offers Triage Insights for Coronavirus Disease 2019 Patients.

Autor:	Beals J 4th; PeraHealth, Inc., Charlotte, NC., Barnes JJ; Department of Medicine, Sinai Hospital of Baltimore, Baltimore, MD., Durand DJ; Department of Innovation and Research, LifeBridge Health, Baltimore, MD., Rimar JM; Yale New Haven Health System, Yale New Haven Hospital, New Haven, CT., Donohue TJ; Yale New Haven Health System, Yale New Haven Hospital, New Haven, CT., Hoq SM; Yale New Haven Health System, Bridgeport Hospital, Bridgeport, CT., Belk KW; PeraHealth, Inc., Charlotte, NC., Amin AN; Irvine Medical Center, The University of California, Orange, CA., Rothman MJ; PeraHealth, Inc., Charlotte, NC.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2021 Apr 05; Vol. 3 (4), pp. e0400. Date of Electronic Publication: 2021 Apr 05 (Print Publication: 2021).
DOI:	10.1097/CCE.0000000000000400
Abstrakt:	Objectives: Triaging patients at admission to determine subsequent deterioration risk can be difficult. This is especially true of coronavirus disease 2019 patients, some of whom experience significant physiologic deterioration due to dysregulated immune response following admission. A well-established acuity measure, the Rothman Index, is evaluated for stratification of patients at admission into high or low risk of subsequent deterioration. Design: Multicenter retrospective study. Setting: One academic medical center in Connecticut, and three community hospitals in Connecticut and Maryland. Patients: Three thousand four hundred ninety-nine coronavirus disease 2019 and 14,658 noncoronavirus disease 2019 adult patients admitted to a medical service between January 1, 2020, and September 15, 2020. Interventions: None. Measurements and Main Results: Performance of the Rothman Index at admission to predict in-hospital mortality or ICU utilization for both general medical and coronavirus disease 2019 populations was evaluated using the area under the curve. Precision and recall for mortality prediction were calculated, high- and low-risk thresholds were determined, and patients meeting threshold criteria were characterized. The Rothman Index at admission has good to excellent discriminatory performance for in-hospital mortality in the coronavirus disease 2019 (area under the curve, 0.81-0.84) and noncoronavirus disease 2019 (area under the curve, 0.90-0.92) populations. We show that for a given admission acuity, the risk of deterioration for coronavirus disease 2019 patients is significantly higher than for noncoronavirus disease 2019 patients. At admission, Rothman Index-based thresholds segregate the majority of patients into either high- or low-risk groups; high-risk groups have mortality rates of 34-45% (coronavirus disease 2019) and 17-25% (noncoronavirus disease 2019), whereas low-risk groups have mortality rates of 2-5% (coronavirus disease 2019) and 0.2-0.4% (noncoronavirus disease 2019). Similarly large differences in ICU utilization are also found. Conclusions: Acuity level at admission may support rapid and effective risk triage. Notably, in-hospital mortality risk associated with a given acuity at admission is significantly higher for coronavirus disease 2019 patients than for noncoronavirus disease 2019 patients. This insight may help physicians more effectively triage coronavirus disease 2019 patients, guiding level of care decisions and resource allocation. Competing Interests: Drs. Beals and Rothman and Belk are employees of PeraHealth, Inc., a company which provides the Rothman Index to hospitals. Drs. Beals and Rothman are shareholders of PeraHealth, Inc. Dr. Amin reports serving as Clinical Trials Principal Investigator/Co-Investigator for the National Institutes of Health/National Institute of Allergy and Infectious Diseases, NeuroRx Pharma, Pulmotect, Blade Therapeutics, Novartis, Takeda, Humanigen, Eli-Lilly, PTC Therapeutics, OctaPharma, Fulcrum Therapeutics, Alexion, and as a consultant and/or speaker for BMS, Pfizer, BI, Portola, Sunovion, Mylan, Salix, Alexion, Astra Zeneca, Novartis, Nabriva, Paratek, Bayer, Tetraphase, Achogen, LaJolla, Millenium, PeraHealth, Aseptiscope, HeartRite, Sprightly Health. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2021 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
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