The Ability of Early Warning Scores to Predict Mortality in Covid 19 Pneumonia

Yıl 2023, , 571 - 578, 28.09.2023

Yunus Emre Arık , Hatice Topcu

https://doi.org/10.53424/balikesirsbd.1246611

Öz

Objective: Early recognition of critical patients is crucial in emergency departments. Many scoring systems are used for it. This study aim determining the prognostic values of these scoring systems for Covid 19 patients. Materials and Methods: This retrospective study was performed between March 2020 -May 2020. 212 patient who have Covid 19 pneumonia were enrolled. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS) and quick Sequential Organ Failure Assessment (qSOFA) scores were calculated according to patients’ admission data. Receiver operating characteristic (ROC) analysis was used to determine the diagnostic values of scores and the optimum cut-off values were determined by Youden Index. Results: Twenty-three (10.84%) of 212 patients died and 34 (16%) were admitted to ICU. The AUC values of MEWS, NEWS, and qSOFA for predicting mortality in < 65 years old were 0.852 (95% confidence interval 0.708-0.997), 0.882 (0.741-1.000) and 0.879 (0.768-0.990) and ≥65 years old 0.854(0.720-0.987), 0.931(0.853-1.000), 0.776(0.609-0.944) respectively. For ICU admission AUC values of MEWS, NEWS and qSOFA in <65 years old followed as; 0.882(0.783-0.981), 0.914(0.817-1.000), 0.868(0.764-0.973) and 0.845(0.725-0.965), 0.926(0.854-0.998), 0.815(0.676-0.954) in ≥ 65 years old. MEWS and qSOFA optimal cut-off values for mortality were ≥2 with 90.0% sensitivity 74.7% specificity and ≥1 with 90.9% sensitivity 78.1% specificity for <65 years, NEWS optimal cut-off is ≥6 with 91.7% sensitivity and 76.7% specificity for ≥ 65 years. Conclusion: These scores have good predictive value for mortality and ICU admission, but NEWS is better especially in ≥ 65 years old patient with Covid 19 pneumonia.

Anahtar Kelimeler

mortality, prediction, covid 19, pneumonia

Erken Uyarı Skorlarının Covid 19 Pnömonisinde Ölüm Oranlarını Öngörme Yeteneği

Öz

Amaç: Acil servislerde kritik hastaların erken tanınması önemlidir. Bunun için birçok puanlama sistemi kullanılmaktadır. Bu çalışma, bu sistemlerin Covid 19 pnömonisinde prognostik değerlerini incelemiştir. Gereç ve Yöntem: Bu retrospektif çalışma Mart 2020- Mayıs 2020 tarihleri arasında yapıldı. Çalışmaya Covid 19 pnömonisi olan 212 hasta dahil edildi. Hastaların National Early Warning Score (NEWS), Modifiye Early Warning Score (MEWS) ve quick sequential organ failure assesment (qSOFA) puanları hesaplandı. Tanısal değerlerinin belirlenmesinde ROC analizi kullanıldı. Optimum eşik değerleri Youden İndeksi ile belirlendi. Bulgular: Toplam 212 hastanın 23'ü (%10.84) öldü, 34'ü (%16) yoğun bakıma alındı. MEWS, NEWS ve qSOFA'nın 65 yaş altı ölüm oranını öngörmeye yönelik eğri altında kalan alanları sırasıyla 0.852 (%95 güven aralığı 0.708-0.997), 0.882 (0.741-1.000) ve 0.879 (0.768-0.990) ve 65 yaş üstü hastalarda ise sırasıyla 0.854 (güven aralığı 0.720-0.987), 0.931(0.853-1.000), 0.776(0.609-0.944) idi. MEWS, NEWS ve qSOFA’nın yoğun bakım yatışını öngörme değerleri 65 yaş altı için sırasıyla 0.882(0.783-0.981), 0.914(0.817-1.000), 0.868(0.764-0.973) iken 65 yaş üstü hastalar için 0.845(0.725-0.965), 0.926(0.854-0.998), 0.815(0.676-0.954) idi. Ölüm oranı için optimal eşik değerleri 65 yaş altında; MEWS ≥2 (%90 duyarlılık, %74.7 özgüllük), qSOFA ≥1 (%90.9 duyarlılık, %78.1 özgüllük) iken 65 yaş üstü hastalarda NEWS ≥6 (%91.7 duyarlılık, %76.7 özgüllük) bulundu. Sonuç: Bu skorlar ölüm ve yoğun bakım yatış oranını öngörmede değerli bulunmuştur, ancak NEWS skorunun özellikle 65 yaş üstü Covid 19 pnömonisi olan hastalarda daha iyi bir gösterge olduğu görülmüştür.

Anahtar Kelimeler

tahmin, covid 19, pnömoni, ölüm oranı

Kaynakça

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