Stratifying risk outcomes among adult COVID-19 inpatients with high flow oxygen: The R4 score.

Autor: Aguirre-García GM; Instituto Tecnologico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico., Ramonfaur D; Harvard Medical School, Division of Postgraduate Medical Education, 25 Shattuck St, Boston, MA 02115, United States., Torre-Amione G; Instituto Tecnologico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico., Ramírez-Elizondo MT; Instituto Tecnologico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico., Lara-Medrano R; Instituto Tecnologico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico., Moreno-Hoyos JF; Instituto Tecnologico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico., Velázquez-Ávila ES; Hospital San Jose-Tec Salud, Epidemiological Surveillance Unit, Monterrey, Nuevo Leon, Mexico., Diaz-Garza CA; Instituto Tecnologico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico., Sanchez-Nava VM; Instituto Tecnologico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico., Castilleja-Leal F; Instituto Tecnologico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico., Rhoades GM; Instituto Tecnologico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico., Martínez-Reséndez MF; Instituto Tecnologico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico; Hospital San Jose-Tec Salud, Epidemiological Surveillance Unit, Monterrey, Nuevo Leon, Mexico. Electronic address: michel.martinez@tecsalud.mx.
Jazyk: angličtina
Zdroj: Pulmonology [Pulmonology] 2023 May-Jun; Vol. 29 (3), pp. 200-206. Date of Electronic Publication: 2021 Oct 12.
DOI: 10.1016/j.pulmoe.2021.10.001
Abstrakt: Background: High flow oxygen therapy (HFO) is a widely used intervention for pulmonary complications. Amid the coronavirus infectious disease 2019 (COVID-19) pandemic, HFO became a popular alternative to conventional oxygen supplementation therapies. Risk stratification tools have been repurposed -and new ones developed- to estimate outcome risks among COVID-19 patients. This study aims to provide a simple risk stratification system to predict invasive mechanical ventilation (IMV) or death among COVID-19 inpatients on HFO.
Methods: Among 529 adult inpatients with COVID-19 pneumonia, we selected unadjusted clinical risk factors for developing the composite endpoint of IMV or death. The risk for the primary outcome by each category was estimated using a Cox proportional hazards model. Bootstrapping was used to validate the results.
Results: Age above 62, eGFR under 60 ml/min, room air SpO2 ≤89 % upon admission, history of hypertension, history of diabetes, and any comorbidity (cancer, cardiovascular disease, COPD/ asthma, hypothyroidism, or autoimmune disease) were considered for the score. Each of the six criteria scored 1 point. The score was further simplified into 4 categories: 1) 0 criteria, 2) 1 criterion, 3) 2-3 criteria, and 4) ≥4 criteria. Taking the first category as the reference, risk estimates for the primary endpoint were HR; 2.94 [1.67 - 5.26], 4.08 [2.63 - 7.05], and 6.63 [3.74 - 11.77], respectively. In ROC analysis, the AUC for the model was 0.72.
Conclusions: Our score uses simple criteria to estimate the risk for IMV or death among COVID-19 inpatients with HFO. Higher category reflects consistent increases in risk for the endpoint.
Competing Interests: Conflicts of interest None.
(Copyright © 2021 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze: MEDLINE