COVİD-19 TANILI HASTALARDA KARDİYAK ARREST RİSKİNİN BELİRLENMESİNDE İKİ FARKLI ERKEN UYARI SKORUNUN KARŞILAŞTIRILMASI: RETROSPEKTİF ANALİZ

Year 2022, Volume: 1 Issue: 1, 44 - 57, 16.03.2022

Nurcan Doruk , Levent Özdemir Aslınur Sagün Bahar Taşdelen , Merve Kök , Enes Yeşilmen

Abstract

Giriş: Durumu kötüleşen hastanın erken tanınması ve gerekli önlemlerin hızla alınması hastalarda kardiyak arrest gelişimini engelleyebilmektedir. Bu amaçla, modifiye erken uyarı skoru (MEUS) ve ulusal erken uyarı skorlama (UEUS) sistemleri geliştirilmiş olmasının yanında, COVİD-19 hastalarına spesifik erken uyarı skoru da (CEUS: ≥ 65 yaş kriteri eklenerek modifiye edilen UEUS) oluşturulmuştur. Bu çalışmada, serviste takip edilen COVİD-19 tanılı hastalarda, yoğun bakım ünitesine (YBÜ) yatış ihtiyacını ve kardiyopulmoner arrest (KPA) gelişme ihtimalini öngörmede MEUS ile CEUS’un karşılaştırılması amaçlanmıştır.

Metod: Etik kurul onayı alındıktan sonra, Mersin Üniversitesi Tıp Fakültesi Hastanesinde 1 Mart 2020-1 Haziran 2020 tarihleri arasında COVİD-19 servisinde yatan 18 yaşından büyük toplam 332 yetişkin hasta çalışmaya dahil edildi. Hasta kayıtlarından demografik verileri ve yandaş hastalıkları incelendi. Servis takip formlarından elde edilen vital bulgular aracılığı ile MEUS ve CEUS skoru hesaplandı. Skorların hesaplanmasında, her bir gün için tekrarlanan ölçümlerin ortalaması kaydedildi.

Bulgular: Hastaların % 60,9’i (n=202) erkek, % 39,1’i (n=130) kadın idi. Hastaların yaş ortalaması 53,73±20,05 olarak hesaplandı. Hastaların yatış süreleri ortalama 6,02±3,73 gün idi. Oksijen ihtiyacı olan hasta oranı % 24,4 (n=81) olarak bulundu. Hastaların COVİD-19 servisinden YBÜ’ye kabul edilme oranı % 1,2 (n=4), KPA oranı % 1,8 (n=6) ve eksitus oranı % 1,8 (n=6) olarak izlendi. Hastaların, her bir gün için aldıkları ortalama MEUS ile CEUS değerleri arasında istatiksel olarak anlamlı fark olduğu saptandı (1,33±0,49’a karşı 2,59±2,39; p˂0,001). KPA gelişen ve gelişmeyen hastaların 1. gün skorları karşılaştırıldığında CEUS skoru, MEUS skoruna göre anlamlı derecede yüksek bulundu (p=0,001’e karşı p=0,283). KPA için, CEUS’da sınır değer 4,75 olarak bulunurken (KPA ve eksitusu öngörme anlamlı, p˂0,001), MEUS için ayırt edici bir cut-off değeri ise saptanamadı (p=0,317). Yandaş hastalığı olanlar (n=204) incelendiğinde CEUS skoru, MEUS’e göre anlamlı derecede yüksek bulundu (p<0,001).

Sonuç: Elde edilen sonuçlara göre UEUS’e yaş kriterinin eklenmesi ile elde edilen CEUS, MEUS’e göre COVİD-19 hastalarında KPA ve eksitusu öngörmede daha duyarlı bir erken uyarı sistemi olabilir.

Keywords

Covid-19, Ulusal erken uyarı skoru, Modifiye erken uyarı skoru, Kardiyak arrest, Kardiyopulmoner resüsitasyon

COMPARISON OF TWO DIFFERENT EARLY WARNING SCORES TO PREDICT THE RISK OF CARDIAC ARREST IN PATIENTS WITH DIAGNOSED COVID-19: RETROSPECTIVE ANALYSIS

Abstract

Introduction: Early recognition of the deteriorating patient and taking the necessary precautions quickly can prevent the development of cardiac arrest in patients. For this purpose, modified early warning scoring (MEWS) and national early warning scoring (NEWS) were developed, as well as specific EWS for COVID-19 patients (CEWS: NEWS modified by adding ≥65 age criterion). In this study, it was aimed to compare MEWS and CEWS to predict worsening and development of cardiopulmonary arrest (CPA) in patients followed up with a diagnosis of COVID-19 in wards.

Methods: After the approval of the ethics committee, a total of 332 adult patients between the ages of 18-99 who were hospitalized in the COVID-19 wards of Mersin University Medical Faculty Hospital between 1 March 2020 and 1 June 2020 were included in the study. Demographic data and comorbidity status were determined from patient records. The MEWS and CEWS scores were determined by the vital findings obtained from the service follow-ups. For these two scorings, the mean of repeated measurements for each day was recorded.

Results: 60.9 % (n=202) of the patients were male and 39.1 % (n=130) were female. The mean age of the patients was calculated as 53.73±20.05. The mean hospitalization period of the patients was 6.02±3.73 days. The rate of patients in requirement of additional oxygen was found to be 24.4 % (n=81). Admission rate from the COVID-19 service to the ICU was 1.2 % (n=4), CPA rate was 1.8 % (n=6) and exitus rate was 1.8% (n=6). The mean scores of the patients for each day were taken, and there was a statistically significant difference between MEWS and CEWS (1.33±0.49 vs. 2.59±2.39; p˂0.001). When the 1st day scores of the patients with and without CPA were compared, the CEWS score was found to be significantly higher than the MEWS score (p=0.001 vs. p=0.283). While the cut-off value was 4.75 in CEWS for CPA (p˂0.001), a distinctive cut-off value was not found for MEWS (p=0.317). When those with comorbidities (n=204) were examined, the CEWS was found to be significantly higher than the MEWS (p<0.001).
Conclusion: According to the results, CEWS obtained by adding age criteria to NEWS, may be a more accurate early warning system in predicting CPA and exitus in COVID-19 patients compared to MEWS.

Keywords

COVID-19, Modified early warning score, National early warning score, Cardiac arrest, Cardiopulmonary resuscitation

References

• Semeraro F, Greif R, Böttiger BW, et al. European Resuscitation Council Guidelines 2021: Systems saving lives. Resuscitation. 2021;161:80-97. doi:10.1016/j. resuscitation.2021.02.008
• Andersen LW, Kim WY, Chase M, et al. The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest. Resuscitation. 2016;98:112-117. doi:10.1016/j. resuscitation.2015.08.016
• Churpek MM, Yuen TC, Winslow C, Hall J, Edelson DP. Differences in vital signs between elderly and nonelderly patients prior to ward cardiac arrest. Crit Care Med 2015;43:816-22.
• 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.
• Mitsunaga T, Hasegawa I, Uzura M, et al. Comparison of the National Early Warning Score (NEWS) and the Modified Early Warning Score (MEWS) for predicting admission and in-hospital mortality in elderly patients in the prehospital setting and in the emergency department. PeerJ. 2019;7:e6947. doi:10.7717/peerj.6947
• Umar A, Ameh CA, Muriithi F, Mathai M. Early warning systems in obstetrics: A systematic literature review. PLoS One. 2019;14(5):e0217864. doi:10.1371/journal. pone.0217864
• Lampin ME, Duhamel A, Behal H, Recher M, Leclerc F, Leteurtre S. Use of paediatric early warning scores in intermediate care units. Arch Dis Child. 2020;105(2):173- 179. doi:10.1136/archdischild-2019-317055
• Hollis RH, Graham LA, Lazenby JP, et al. A Role for the Early Warning Score in Early Identification of Critical Postoperative Complications. Ann Surg. 2016;263(5):918- 923. doi:10.1097/SLA.0000000000001514
• Martín-Rodríguez F, Martín-Conty JL, Sanz-García A, et al. Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments. J Pers Med. 2021;11(3):170. doi:10.3390/jpm11030170
• Semeraro F, Scquizzato T, Scapigliati A, et al. New Early Warning Score: off-label approach for Covid-19 outbreak patient deterioration in the community. Resuscitation. 2020;151:24-25. doi:10.1016/j.resuscitation.2020.04.018
• Vrillon A, Hourregue C, Azuar J, et al. COVID-19 in Older Adults: A Series of 76 Patients Aged 85 Years and Older with COVID-19. J Am Geriatr Soc. 2020;68(12):2735-2743. doi:10.1111/jgs.16894
• Mat Din H, Raja Adnan RNE, Nor Akahbar SA, Ahmad SA. Characteristics of COVID-19-Related Deaths Among Older Adults in Malaysia. Malays J Med Sci. 2021;28(4):138-145. doi:10.21315/mjms2021.28.4.14
• Hu H, Yao N, Qiu Y. Comparing Rapid Scoring Systems in Mortality Prediction of Critically Ill Patients With Novel Coronavirus Disease. Acad Emerg Med. 2020;27(6):461-468. doi:10.1111/acem.13992
• Chen Z, Cheng Z, Zhang X, et al. Clinical manifestations and CT characteristics of corona virus disease 2019 (COVID-19). Radiol Pract 2020;3:286–90.
• Smith ME, Chiovaro JC, O’Neil M, et al. Early warning system scores for clinical deterioration in hospitalized patients: a systematic review. Ann Am Thorac Soc. 2014;11(9):1454- 1465. doi:10.1513/AnnalsATS.201403-102OC
• Peng B, Zhou W, Pettit RW, et al. Reducing COVID-19 quarantine with SARS-CoV-2 testing: a simulation study. BMJ Open. 2021;11(7):e050473. doi:10.1136/ bmjopen-2021-050473
• Jang JG, Hur J, Hong KS, Lee W, Ahn JH. Prognostic Accuracy of the SIRS, qSOFA, and NEWS for Early Detection of Clinical Deterioration in SARS-CoV-2 Infected Patients. J Korean Med Sci. 2020;35(25):e234. Published 2020 Jun 29. doi:10.3346/jkms.2020.35.e234
• McGinley A, Pearse RM. A national early warning score for acutely ill patients. BMJ 2012;345:e5310.
• Goulden R, Hoyle MC, Monis J, Railton D, Riley V, Martin P, et al. qSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis. Emerg Med J 2018;35(6):345-9.
• Churpek MM, Snyder A, Han X, et al. Quick Sepsis-related organ failure assessment, systemic inflammatory response syndrome, and early warning scores for detecting clinical deterioration in infected patients outside the intensive care unit. Am J Respir Crit Care Med 2017;195(7):906-11.
• Sun Q, Qiu H, Huang M, Yang Y. Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu province. Ann Intensive Care 2020;10(1):33.