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Liu A, Hammond R, Chan K, Chukwuenweniwe C, Johnson R, Khair D, Duck E, Olubodun O, Barwick K, Banya W, Stirrup J, Donnelly PD, Kaski JC, Coates ARM. Low CRB-65 Scores Effectively Rule out Adverse Clinical Outcomes in COVID-19 Irrespective of Chest Radiographic Abnormalities. Biomedicines 2023; 11:2423. [PMID: 37760863 PMCID: PMC10525183 DOI: 10.3390/biomedicines11092423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Background: CRB-65 (Confusion; Respiratory rate ≥ 30/min; Blood pressure ≤ 90/60 mmHg; age ≥ 65 years) is a risk score for prognosticating patients with COVID-19 pneumonia. However, a significant proportion of COVID-19 patients have normal chest X-rays (CXRs). The influence of CXR abnormalities on the prognostic value of CRB-65 is unknown, limiting its wider applicability. Methods: We assessed the influence of CXR abnormalities on the prognostic value of CRB-65 in COVID-19. Results: In 589 study patients (71 years (IQR: 57-83); 57% males), 186 (32%) had normal CXRs. On ROC analysis, CRB-65 performed similarly in patients with normal vs. abnormal CXRs for predicting inpatient mortality (AUC 0.67 ± 0.05 vs. 0.69 ± 0.03). In patients with normal CXRs, a CRB-65 of 0 ruled out mortality, NIV requirement and critical illness (intubation and/or ICU admission) with negative predictive values (NPVs) of 94%, 98% and 99%, respectively. In patients with abnormal CXRs, a CRB-65 of 0 ruled out the same endpoints with NPVs of 91%, 83% and 86%, respectively. Patients with low CRB-65 scores had better inpatient survival than patients with high CRB-65 scores, irrespective of CXR abnormalities (all p < 0.05). Conclusions: CRB-65, CXR and CRP are independent predictors of mortality in COVID-19. Adding CXR findings (dichotomised to either normal or abnormal) to CRB-65 does not improve its prognostic accuracy. A low CRB-65 score of 0 may be a good rule-out test for adverse clinical outcomes in COVID-19 patients with normal or abnormal CXRs, which deserves prospective validation.
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Affiliation(s)
- Alexander Liu
- School of Medicine, University of St Andrews, St Andrews KY16 9TF, UK; (A.L.); (R.H.); (P.D.D.)
| | - Robert Hammond
- School of Medicine, University of St Andrews, St Andrews KY16 9TF, UK; (A.L.); (R.H.); (P.D.D.)
| | - Kenneth Chan
- Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK; (K.C.); (C.C.); (R.J.); (D.K.); (E.D.); (O.O.); (K.B.); (J.S.)
| | - Chukwugozie Chukwuenweniwe
- Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK; (K.C.); (C.C.); (R.J.); (D.K.); (E.D.); (O.O.); (K.B.); (J.S.)
| | - Rebecca Johnson
- Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK; (K.C.); (C.C.); (R.J.); (D.K.); (E.D.); (O.O.); (K.B.); (J.S.)
| | - Duaa Khair
- Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK; (K.C.); (C.C.); (R.J.); (D.K.); (E.D.); (O.O.); (K.B.); (J.S.)
| | - Eleanor Duck
- Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK; (K.C.); (C.C.); (R.J.); (D.K.); (E.D.); (O.O.); (K.B.); (J.S.)
| | - Oluwaseun Olubodun
- Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK; (K.C.); (C.C.); (R.J.); (D.K.); (E.D.); (O.O.); (K.B.); (J.S.)
| | - Kristian Barwick
- Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK; (K.C.); (C.C.); (R.J.); (D.K.); (E.D.); (O.O.); (K.B.); (J.S.)
| | | | - James Stirrup
- Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK; (K.C.); (C.C.); (R.J.); (D.K.); (E.D.); (O.O.); (K.B.); (J.S.)
| | - Peter D. Donnelly
- School of Medicine, University of St Andrews, St Andrews KY16 9TF, UK; (A.L.); (R.H.); (P.D.D.)
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George’s University of London, London SW17 0QT, UK;
| | - Anthony R. M. Coates
- Institute of Infection and Immunity, St George’s University of London, London SW17 0QT, UK
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Disparities in Level of Care and Outcomes Among Patients with COVID-19: Associations Between Race/Ethnicity, Social Determinants of Health and Virtual Hospitalization, Inpatient Hospitalization, Intensive Care, and Mortality. J Racial Ethn Health Disparities 2023; 10:859-869. [PMID: 35290647 PMCID: PMC8922978 DOI: 10.1007/s40615-022-01274-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To examine the role of race/ethnicity and social determinants of health on COVID-19 care and outcomes for patients within a healthcare system that provided virtual hospital care. METHODS This retrospective cohort study included 12,956 adults who received care for COVID-19 within an integrated healthcare system between 3/1/2020 and 8/31/2020. Multinomial models were used to examine associations between race/ethnicity, insurance, neighborhood deprivation measured by Area Deprivation Index (ADI), and outcomes of interest. Outcomes included (1) highest level of care: virtual observation (VOU), virtual hospitalization (VACU), or inpatient hospitalization; (2) intensive care (ICU); and (3) all-cause 30-day mortality. RESULTS Patients were 41.8% White, 27.2% Black, and 31.0% Hispanic. Compared to White patients, Black patients had 1.86 higher odds of VACU admission and 1.43 higher odds of inpatient hospitalization (vs. VOU). Hispanic patients had 1.24 higher odds of inpatient hospitalization (vs. VOU). In models stratified by race/ethnicity, Hispanic and Black patients had higher odds of inpatient hospitalization (vs. VOU) if Medicaid insured compared to commercially insured. Hispanic patients living in the most deprived neighborhood had higher odds of inpatient hospitalization, compared to those in the least deprived neighborhood. Black and Hispanic patients had higher odds of ICU admission and 30-day mortality after adjustment for other social determinants. CONCLUSIONS Insurance and ADI were associated with COVID-19 outcomes; however, associations varied by race/ethnicity. Racial/ethnic disparities in outcomes are not fully explained by measured social determinants of health, highlighting the need for further investigation into systemic causes of inequities in COVID-19 outcomes.
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Prasetyo NE, Satoto B, Handoyo T. The relevance of chest X-ray radiologic severity index and CURB-65 score with the death event in hospitalized patient with COVID-19 pneumonia. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [PMCID: PMC9403221 DOI: 10.1186/s43055-022-00877-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The global pandemic respiratory infection COVID-19 has had a high mortality rate since early 2020 with a broad spectrum of symptoms and giving a high burden. This study used the chest X-ray radiologic severity index method to radiologically assess the degree of lung lesions and the CURB-65 score to clinically assess COVID-19 pneumonia patients associated with the incidence of death in hospitalized patients. Results The research data were carried out from March 2020 to April 2021 based on patient medical records and chest X-rays at Doctor Kariadi General Hospital Semarang Indonesia. One hundred and five subjects were collected that fulfilled the inclusion and exclusion criteria. The CURB-65 score ≥ 2 had a significant relationship to the death event with a prevalence interval of 2.98 (95% CI, p = 0.000). The radiologic severity index ≥ 22.5 in initial chest X-ray signified a prevalence ratio of 2.24 (CI 95%, p = 0.004) and the radiologic severity index ≥ 29.5 in the second chest X-ray signified a prevalence ratio of 4.53 for the incidence of death (95% CI, p = 0.000). The combination of CURB-65 and the first chest X-ray radiologic severity index resulted in a prevalence ratio of 27.44, and the combination of CURB-65 and the second chest X-ray radiologic severity index resulted in a prevalence ratio of 60.2 which were significant for the mortality of hospitalized COVID-19 pneumonia patients. Conclusions Chest X-ray radiologic severity index and CURB-65 score have a significant relevance with the death event in hospitalized patients with COVID-19 pneumonia and can thus be used as a predictor of mortality.
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Dey S, Magoon R, Kohli JK, Kashav RC, ItiShri I, Walian A. Shock Index in COVID Era. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0041-1739499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractThe health care burden and risks to health care workers imposed by novel coronavirus disease 2019 (COVID-19) mandated the need for a simple, noninvasive, objective, and parsimonious risk stratification system predicting the level of care, need for definitive airway, and titration of the ongoing patient care. Shock index (SI = heart rate/systolic blood pressure) has been evaluated in emergency triage, sepsis, and trauma settings including different age group of patients. The ever accumulating girth of evidences demonstrated a superior predictive value of SI over other hemodynamic parameters. Inclusion of respiratory and/or neurological parameters and adjustment of the cutoffs appropriate to patient age increase the predictability in the trauma and sepsis scenario. Being reproducible, dynamic, and simple, SI can be a valuable patient risk stratification tool in this ongoing era of COVID-19 pandemic.
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Affiliation(s)
- Souvik Dey
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Rohan Magoon
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Jasvinder Kaur Kohli
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ramesh Chand Kashav
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - ItiShri ItiShri
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ashish Walian
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Jamshidi E, Asgary A, Tavakoli N, Zali A, Setareh S, Esmaily H, Jamaldini SH, Daaee A, Babajani A, Sendani Kashi MA, Jamshidi M, Jamal Rahi S, Mansouri N. Using Machine Learning to Predict Mortality for COVID-19 Patients on Day 0 in the ICU. Front Digit Health 2022; 3:681608. [PMID: 35098205 PMCID: PMC8792458 DOI: 10.3389/fdgth.2021.681608] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/22/2021] [Indexed: 01/28/2023] Open
Abstract
Rationale: Given the expanding number of COVID-19 cases and the potential for new waves of infection, there is an urgent need for early prediction of the severity of the disease in intensive care unit (ICU) patients to optimize treatment strategies. Objectives: Early prediction of mortality using machine learning based on typical laboratory results and clinical data registered on the day of ICU admission. Methods: We retrospectively studied 797 patients diagnosed with COVID-19 in Iran and the United Kingdom (U.K.). To find parameters with the highest predictive values, Kolmogorov-Smirnov and Pearson chi-squared tests were used. Several machine learning algorithms, including Random Forest (RF), logistic regression, gradient boosting classifier, support vector machine classifier, and artificial neural network algorithms were utilized to build classification models. The impact of each marker on the RF model predictions was studied by implementing the local interpretable model-agnostic explanation technique (LIME-SP). Results: Among 66 documented parameters, 15 factors with the highest predictive values were identified as follows: gender, age, blood urea nitrogen (BUN), creatinine, international normalized ratio (INR), albumin, mean corpuscular volume (MCV), white blood cell count, segmented neutrophil count, lymphocyte count, red cell distribution width (RDW), and mean cell hemoglobin (MCH) along with a history of neurological, cardiovascular, and respiratory disorders. Our RF model can predict patient outcomes with a sensitivity of 70% and a specificity of 75%. The performance of the models was confirmed by blindly testing the models in an external dataset. Conclusions: Using two independent patient datasets, we designed a machine-learning-based model that could predict the risk of mortality from severe COVID-19 with high accuracy. The most decisive variables in our model were increased levels of BUN, lowered albumin levels, increased creatinine, INR, and RDW, along with gender and age. Considering the importance of early triage decisions, this model can be a useful tool in COVID-19 ICU decision-making.
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Affiliation(s)
- Elham Jamshidi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Asgary
- Department of Biotechnology, College of Sciences, University of Tehran, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soroush Setareh
- Department of Biotechnology, College of Sciences, University of Tehran, Tehran, Iran
| | - Hadi Esmaily
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Jamaldini
- Department of Genetic, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Amir Daaee
- School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Amirhesam Babajani
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Masoud Jamshidi
- Department of Exercise Physiology, Tehran University, Tehran, Iran
| | - Sahand Jamal Rahi
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Nahal Mansouri
- Division of Pulmonary Medicine, Department of Medicine, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Laboratory of the Physics of Biological Systems, Institute of Physics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Carriel J, Muñoz-Jaramillo R, Bolaños-Ladinez O, Heredia-Villacreses F, Menéndez-Sanchón J, Martin-Delgado J. CURB-65 as a predictor of 30-day mortality in patients hospitalized with COVID-19 in Ecuador: COVID-EC study. Rev Clin Esp 2022; 222:37-41. [PMID: 34996587 PMCID: PMC8086802 DOI: 10.1016/j.rceng.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/14/2020] [Indexed: 11/27/2022]
Abstract
Objective This article aims to assess the utility of CURB-65 in predicting 30-day mortality in adult patients hospitalized with COVID-19. Methods This work is a cohort study conducted between March 1 and April 30, 2020 in Ecuador. Results A total of 247 patients were included (mean age 60 ± 14 years, 70% men, overall mortality 41.3%). Patients with CURB-65 ≥ 2 had a higher mortality rate (57 vs. 17%, p < .001) that was associated with other markers of risk: advanced age, hypertension, overweight/obesity, kidney failure, hypoxemia, requirement for mechanical ventilation, or onset of respiratory distress. Conclusions CURB-65 ≥ 2 was associated with higher 30-day mortality on the univariate (Kaplan–Meier estimator) and multivariate (Cox regression) analysis.
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Affiliation(s)
- J Carriel
- Servicio de Medicina Interna, Hospital Universitario La Zarzuela, Madrid, Spain; Instituto de Investigación e Innovación en Salud integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.
| | - R Muñoz-Jaramillo
- Servicio de Gastroenterología, Hospital IESS Ceibos, Guayaquil, Ecuador
| | - O Bolaños-Ladinez
- Servicio de Medicina Intensiva, Servicio de Cardiología, Hospital Clínica San Francisco, Guayaquil, Ecuador
| | - F Heredia-Villacreses
- Servicio de Medicina Intensiva, Servicio de Cardiología, Hospital Clínica San Francisco, Guayaquil, Ecuador
| | - J Menéndez-Sanchón
- Servicio de Medicina Interna, Hospital General Guasmo Sur, Guayaquil, Ecuador
| | - J Martin-Delgado
- Grupo de Investigación Atenea, Fundación para el Fomento de la Investigación Sanitaria y Biomédica, San Juan de Alicante, Alicante, Spain
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Ramos-Rincón JM, Bernabeu-Whittel M, Fiteni-Mera I, López-Sampalo A, López-Ríos C, García-Andreu MDM, Mancebo-Sevilla JJ, Jiménez-Juan C, Matía-Sanz M, López-Quirantes P, Rubio-Rivas M, Paredes-Ruiz D, González-San-Narciso C, González-Vega R, Sanz-Espinosa P, Hernández-Milián A, Gonzalez-Noya A, Gil-Sánchez R, Boixeda R, Alcalá-Pedrajas JN, Palop-Cervera M, Cortés-Rodríguez B, Guisado-Espartero ME, Mella-Pérez C, Gómez-Huelgas R. Clinical features and risk factors for mortality among long-term care facility residents hospitalized due to COVID-19 in Spain. J Gerontol A Biol Sci Med Sci 2021; 77:e138-e147. [PMID: 34626477 DOI: 10.1093/gerona/glab305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 severely impacted older adults and long-term care facility (LTCF) residents. Our primary aim was to describe differences in clinical and epidemiological variables, in-hospital management, and outcomes between LTCF residents and community-dwelling older adults hospitalized with COVID-19. The secondary aim was to identify risk factors for mortality due to COVID-19 in hospitalized LTCF residents. METHODS This is a cross-sectional analysis within a retrospective cohort of hospitalized patients≥75 years with confirmed COVID-19 admitted to 160 Spanish hospitals. Differences between groups and factors associated with mortality among LTCF residents were assessed through comparisons and logistic regression analysis. RESULTS Of 6,189 patients≥75 years, 1,185 (19.1%) were LTCF residents and 4,548 (73.5%) were community-dwelling. LTCF residents were older (median: 87.4 vs. 82.1 years), mostly female (61.6% vs. 43.2%), had more severe functional dependence (47.0% vs 7.8%), more comorbidities (Charlson Comorbidity Index: 6 vs 5), had dementia more often (59.1% vs. 14.4%), and had shorter duration of symptoms (median: 3 vs 6 days) than community-dwelling patients (all, p<.001). Mortality risk factors in LTCF residents were severe functional dependence (aOR:1.79;95%CI:1.13-2.83;p=.012), dyspnea (1.66;1.16-2.39;p=.004), SatO2<94% (1.73;1.27-2.37;p=.001), temperature≥37.8ºC (1.62;1.11-2.38; p=.013); qSOFA index≥2 (1.62;1.11-2.38;p=.013), bilateral infiltrates (1.98;1.24-2.98;p<.001), and high C-reactive protein (1.005;1.003-1.007;p<.001). In-hospital mortality was initially higher among LTCF residents (43.3% vs 39.7%), but lower after adjusting for sex, age, functional dependence, and comorbidities (aOR:0.74,95%CI:0.62-0.87;p<.001). CONCLUSION Basal functional status and COVID-19 severity are risk factors of mortality in LTCF residents. The lower adjusted mortality rate in LTCF residents may be explained by earlier identification, treatment, and hospitalization for COVID-19.
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Affiliation(s)
| | - Máximo Bernabeu-Whittel
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain.,Medicine Department, University of Seville, Sevilla, Spain
| | | | - Almudena López-Sampalo
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Carmen López-Ríos
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain
| | | | - Juan-José Mancebo-Sevilla
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Carlos Jiménez-Juan
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain
| | - Marta Matía-Sanz
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Spain
| | - Pablo López-Quirantes
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Manuel Rubio-Rivas
- Internal Medicine Department. Bellvitge University Hospital- -IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Diana Paredes-Ruiz
- Internal Medicine Department. 12 Octubre University Hospital, Madrid, Spain
| | | | - Rocío González-Vega
- Internal Medicine Department, Costa del Sol Hospital, Marbella (Malaga), Spain
| | - Pablo Sanz-Espinosa
- Internal Medicine Department. Rio Hortega University Hospital, Valladolid, Spain
| | | | - Amara Gonzalez-Noya
- Internal Medicine Department, Ourense University Hospital Complex, Ourense, Spain
| | | | - Ramon Boixeda
- Internal Medicine Department. Mataró Hospital, Mataró (Barcelona), Spain
| | | | - Marta Palop-Cervera
- Internal Medicine Department. Sagunto University Hospital, Sagunto (Valencia), Spain
| | | | | | - Carmen Mella-Pérez
- Internal Medicine Department, Ferrol University Hospital Complex, (Ferrol) A Coruna, Spain
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain.,Medicine Department, University of Malaga, Malaga, Spain
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Doğanay F, Ak R. Performance of the CURB-65, ISARIC-4C and COVID-GRAM scores in terms of severity for COVID-19 patients. Int J Clin Pract 2021; 75:e14759. [PMID: 34455674 PMCID: PMC8646358 DOI: 10.1111/ijcp.14759] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/07/2021] [Accepted: 08/27/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the COVID-19 pandemic, difficulties have been experienced in the provision of healthcare services because of excessive patient admissions to hospitals and emergency departments. It has become important to use clear and objective criteria for the early diagnosis of patients with high-risk classification and clinical worsening risk. OBJECTIVE The aim of this study was to assess the prognostic accuracy of CURB-65, ISARIC-4C and COVID-GRAM scores in patients hospitalised for COVID-19 and to compare the scoring systems in terms of predicting in-hospital mortality and intensive care unit requirement. METHODS The files of all COVID-19 patients over the age of 18 who were admitted to the emergency department and hospitalised between September 1, 2020 and December 1, 2020 were retrospectively scanned. The area under the receiver operating characteristic curve and Youden J Index were used to compare scoring systems for predicting in-hospital mortality and intensive care requirement. RESULTS There were 481 patients included in this study. The median age of the patients was 67 (52-79). In terms of in-hospital mortality, the AUC of CURB-65, ISARIC-4C and COVID-GRAM were 0.846, 0.784 and 0.701 respectively. In terms of intensive care requirement, the AUC of CURB-65, ISARIC-4C and COVID-GRAM were 0.898, 0.797 and 0.684 respectively. In our study, Youden's J indexes of CURB-65, ISARIC-4C and COVID-GRAM scores were found to be 0.59, 0.27 and 0.01 respectively, for mortality prediction of COVID-19 patients. Whereas Youden's J indexes were found to be 0.63, 0.26 and 0.01 respectively for determining intensive care requirement. CONCLUSIONS Among the scoring systems assessed, CURB-65 score had better performance in predicting in-hospital mortality and ICU requirement in COVID-19 patients. ISARIC-4C has been found successful in identifying low-risk patients and the use of the ISARIC-4C score with CURB-65 increases the accuracy of risk assessment.
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Affiliation(s)
- Fatih Doğanay
- Department of Emergency MedicineEdremit State HospitalBalıkesirTurkey
| | - Rohat Ak
- Department of Emergency MedicineDr. Lütfi Kırdar Kartal Eğitim ve Araştırma HastanesiIstanbulTurkey
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Pantazopoulos I, Tsikrika S, Kolokytha S, Manos E, Porpodis K. Management of COVID-19 Patients in the Emergency Department. J Pers Med 2021; 11:jpm11100961. [PMID: 34683102 PMCID: PMC8537207 DOI: 10.3390/jpm11100961] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 is an emerging disease of global public health concern. As the pandemic overwhelmed emergency departments (EDs), a restructuring of emergency care delivery became necessary in many hospitals. Furthermore, with more than 2000 papers being published each week, keeping up with ever-changing information has proven to be difficult for emergency physicians. The aim of the present review is to provide emergency physician with a summary of the current literature regarding the management of COVID-19 patients in the emergency department.
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Affiliation(s)
- Ioannis Pantazopoulos
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 415 00 Larissa, Greece
- Correspondence: ; Tel.: +30-694-566-1525
| | - Stamatoula Tsikrika
- Emergency Department, Thoracic Diseases COVID-19 Referral Hospital “SOTIRIA”, 115 27 Athens, Greece;
| | - Stavroula Kolokytha
- Department of Emergency Medicine, Sismanoglio Hospital, 151 26 Athens, Greece;
| | - Emmanouil Manos
- Pulmonary Clinic, General Hospital of Lamia, 351 00 Lamia, Greece;
| | - Konstantinos Porpodis
- Respiratory Medicine Department, Aristotle University of Thessaloniki, G Papanikolaou Hospital, 570 10 Thessaloniki, Greece;
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Aboueshia M, Hussein MH, Attia AS, Swinford A, Miller P, Omar M, Toraih EA, Saba N, Safah H, Duchesne J, Kandil E. Cancer and COVID-19: analysis of patient outcomes. Future Oncol 2021; 17:3499-3510. [PMID: 34263660 PMCID: PMC8284249 DOI: 10.2217/fon-2021-0121] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: We sought to investigate the outcomes associated with COVID-19 disease in cancer patients. Methods: We conducted a retrospective cohort study of laboratory-confirmed COVID-19 patients. Results: Of the 206 patients included, 57 had at least one preexisting malignancy. Cancer patients were older than noncancer patients. Of the 185 discharged cases, cancer patients had a significantly higher frequency of unplanned reintubation (7.1% vs 0.9%, p < 0.049), and required longer hospital stay (8.58 ± 6.50 days versus 12.83 ± 11.44 days, p < 0.002). Regression analysis revealed that obesity and active smoking were associated with an increased risk of mortality. Conclusion: Outcomes in COVID-19 appear to be driven by obesity as well as active smoking, with no difference in mortality between cancer and noncancer patients. In this study, we aimed to investigate how COVID-19 affected cancer patients and whether this altered their survival outcomes. To do this, we examined data from a database of patients who have passed through our institution – a retrospective cohort analysis. Of the 206 patients we included in the study from this database, 57 had at least one preexisting cancer. Cancer patients tended to be older than noncancer patients. Of the 185 discharged patients, cancer patients required longer hospital stays, but there was no difference in mortality. Disease complications and intensive care unit admission with obesity and active smoking put patients in our cohort at increased risk of death. To conclude, outcomes in COVID-19 patients appear to be driven by obesity as well as active smoking, with no difference in mortality between cancer and noncancer patients.
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Affiliation(s)
- Mohamed Aboueshia
- Department of Surgery, Division of Endocrine & Oncologic Surgery, Tulane University, School of Medicine, New Orleans, LA 70112, USA.,Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Mohammad Hosny Hussein
- Department of Surgery, Division of Endocrine & Oncologic Surgery, Tulane University, School of Medicine, New Orleans, LA 70112, USA
| | - Abdallah S Attia
- Department of Surgery, Division of Endocrine & Oncologic Surgery, Tulane University, School of Medicine, New Orleans, LA 70112, USA
| | - Aubrey Swinford
- Tulane University, School of Medicine, New Orleans, LA 70112, USA
| | - Peter Miller
- Tulane University, School of Medicine, New Orleans, LA 70112, USA
| | - Mahmoud Omar
- Department of Surgery, Division of Endocrine & Oncologic Surgery, Tulane University, School of Medicine, New Orleans, LA 70112, USA
| | - Eman Ali Toraih
- Department of Surgery, Division of Endocrine & Oncologic Surgery, Tulane University, School of Medicine, New Orleans, LA 70112, USA.,Department of Histology & Cell Biology, Genetics Unit, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Nakhle Saba
- Section of Hematology & Medical Oncology, Deming Department of Medicine, Tulane University, New Orleans, LA 70112 USA
| | - Hana Safah
- Section of Hematology & Medical Oncology, Deming Department of Medicine, Tulane University, New Orleans, LA 70112 USA
| | - Juan Duchesne
- Trauma/Acute Care & Critical Care, Department of Surgery, Tulane, Tulane School of Medicine, New Orleans, LA 70112, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112 USA
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11
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Beals J, Barnes JJ, Durand DJ, Rimar JM, Donohue TJ, Hoq SM, Belk KW, Amin AN, Rothman MJ. Stratifying Deterioration Risk by Acuity at Admission Offers Triage Insights for Coronavirus Disease 2019 Patients. Crit Care Explor 2021; 3:e0400. [PMID: 33937866 PMCID: PMC8084057 DOI: 10.1097/cce.0000000000000400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
| | - Jaime J Barnes
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, MD
| | - Daniel J Durand
- Department of Innovation and Research, LifeBridge Health, Baltimore, MD
| | - Joan M Rimar
- Yale New Haven Health System, Yale New Haven Hospital, New Haven, CT
| | - Thomas J Donohue
- Yale New Haven Health System, Yale New Haven Hospital, New Haven, CT
| | - S Mahfuz Hoq
- Yale New Haven Health System, Bridgeport Hospital, Bridgeport, CT
| | | | - Alpesh N Amin
- Irvine Medical Center, The University of California, Orange, CA
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12
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Ramos-Rincon JM, Buonaiuto V, Ricci M, Martín-Carmona J, Paredes-Ruíz D, Calderón-Moreno M, Rubio-Rivas M, Beato-Pérez JL, Arnalich-Fernández F, Monge-Monge D, Vargas-Núñez JA, Acebes-Repiso G, Mendez-Bailon M, Perales-Fraile I, García-García GM, Guisado-Vasco P, Abdelhady-Kishta A, Pascual-Pérez MDLR, Rodríguez-Fernández-Viagas C, Montaño-Martínez A, López-Ruiz A, Gonzalez-Juarez MJ, Pérez-García C, Casas-Rojo JM, Gómez-Huelgas R. Clinical Characteristics and Risk Factors for Mortality in Very Old Patients Hospitalized With COVID-19 in Spain. J Gerontol A Biol Sci Med Sci 2021; 76:e28-e37. [PMID: 33103720 PMCID: PMC7797762 DOI: 10.1093/gerona/glaa243] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Indexed: 01/08/2023] Open
Abstract
Background Advanced age is a well-known risk factor for poor prognosis in COVID-19. However, few studies have specifically focused on very old inpatients with COVID-19. This study aims to describe the clinical characteristics of very old inpatients with COVID-19 and identify risk factors for in-hospital mortality at admission. Methods We conducted a nationwide, multicenter, retrospective, observational study in patients ≥ 80 years hospitalized with COVID-19 in 150 Spanish hospitals (SEMI-COVID-19) Registry (March 1–May 29, 2020). The primary outcome was in-hospital mortality. A uni- and multivariate logistic regression was performed to assess predictors of mortality at admission. Results A total of 2772 consecutive patients (49.4% men, median age 86.3 years) were analyzed. Rates of atherosclerotic cardiovascular disease, diabetes mellitus, dementia, and Barthel Index < 60 were 30.8%, 25.6%, 30.5%, and 21.0%, respectively. The overall case-fatality rate was 46.9% (n: 1301) and increased with age (80–84 years: 41.6%; 85–90 years: 47.3%; 90–94 years: 52.7%; ≥95 years: 54.2%). After analysis, male sex and moderate-to-severe dependence were independently associated with in-hospital mortality; comorbidities were not predictive. At admission, independent risk factors for death were: oxygen saturation < 90%; temperature ≥ 37.8°C; quick sequential organ failure assessment (qSOFA) score ≥ 2; and unilateral–bilateral infiltrates on chest x-rays. Some analytical findings were independent risk factors for death, including estimated glomerular filtration rate < 45 mL/min/1.73 m2; lactate dehydrogenase ≥ 500 U/L; C-reactive protein ≥ 80 mg/L; neutrophils ≥ 7.5 × 103/μL; lymphocytes < 0.8 × 103/μL; and monocytes < 0.5 × 103/μL. Conclusions This first large, multicenter cohort of very old inpatients with COVID-19 shows that age, male sex, and poor preadmission functional status—not comorbidities—are independently associated with in-hospital mortality. Severe COVID-19 at admission is related to poor prognosis.
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Affiliation(s)
| | - Verónica Buonaiuto
- Internal Medicine Department, Málaga Regional University Hospital, Spain
| | - Michele Ricci
- Internal Medicine Department, Málaga Regional University Hospital, Spain
| | | | - Diana Paredes-Ruíz
- Internal Medicine Department, 12 de Octubre University Hospital, Madrid, Spain
| | | | - Manel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital, L'Hospitalet de Llobregat (Barcelona), Spain
| | | | | | | | | | | | | | - Isabel Perales-Fraile
- Internal Medicine Department, Infanta Sofía Hospital, S. S. de los Reyes, Madrid, Spain
| | | | - Pablo Guisado-Vasco
- Internal Medicine Department, Quironsalud Madrid University Hospital, Pozuelo de Alarcón, Spain
| | | | | | | | | | - Antonio López-Ruiz
- Internal Medicine Department, Axarquía Hospital, Vélez-Málaga, Málaga, Spain
| | | | - Cristina Pérez-García
- Internal Medicine Department, Do Salnes Hospital, Vilagarcía de Arousa (Pontevedra), Spain
| | - José-Manuel Casas-Rojo
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, Madrid, Spain
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13
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Demir MC, Ilhan B. Performance of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score among patients with COVID-19 pneumonia in an emergency department triage setting: a retrospective study. SAO PAULO MED J 2021; 139:170-177. [PMID: 33681885 PMCID: PMC9632522 DOI: 10.1590/1516-3180.2020.0649.r1.10122020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.
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Affiliation(s)
- Mehmet Cihat Demir
- MD. Assistant Professor, Department of Emergency Medicine, Düzce University School of Medicine, Düzce, Turkey.
| | - Buğra Ilhan
- MD. Attending Emergency Physician, Department of Emergency Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
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14
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Bels JLM, van Kuijk SMJ, Ghossein-Doha C, Tijssen FH, van Gassel RJJ, Tas J, Collaborators M, Schnabel RM, Aries MJH, van de Poll MCG, Bergmans DCJJ, Meex SJR, van Mook WNKA, van der Horst ICC, van Bussel BCT. Decreased serial scores of severe organ failure assessments are associated with survival in mechanically ventilated patients; the prospective Maastricht Intensive Care COVID cohort. J Crit Care 2020; 62:38-45. [PMID: 33246196 PMCID: PMC7669472 DOI: 10.1016/j.jcrc.2020.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023]
Abstract
Background The majority of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are admitted to the Intensive Care Unit (ICU) for mechanical ventilation. The role of multi-organ failure during ICU admission as driver for outcome remains to be investigated yet. Design and setting Prospective cohort of mechanically ventilated critically ill with SARS-CoV-2 infection. Participants and methods 94 participants of the MaastrICCht cohort (21% women) had a median length of stay of 16 days (maximum of 77). After division into survivors (n = 59) and non-survivors (n = 35), we analysed 1555 serial SOFA scores using linear mixed-effects models. Results Survivors improved one SOFA score point more per 5 days (95% CI: 4–8) than non-survivors. Adjustment for age, sex, and chronic lung, renal and liver disease, body-mass index, diabetes mellitus, cardiovascular risk factors, and Acute Physiology and Chronic Health Evaluation II score did not change this result. This association was stronger for women than men (P-interaction = 0.043). Conclusions The decrease in SOFA score associated with survival suggests multi-organ failure involvement during mechanical ventilation in patients with SARS-CoV-2. Surviving women appeared to improve faster than surviving men. Serial SOFA scores may unravel an unfavourable trajectory and guide decisions in mechanically ventilated patients with SARS-CoV-2.
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Affiliation(s)
- Julia L M Bels
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Chahinda Ghossein-Doha
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; Department of Cardiology, Maastricht University Medical Centre+, Maastricht, the Netherlands; School for Oncology & Developmental Biology (GROW), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
| | - Fabian H Tijssen
- Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Rob J J van Gassel
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
| | - Jeanette Tas
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - MaastrICCht Collaborators
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands
| | - Ronny M Schnabel
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands.
| | - Marcel J H Aries
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Marcel C G van de Poll
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
| | - Dennis C J J Bergmans
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands.
| | - Steven J R Meex
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.
| | - Walther N K A van Mook
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; School of Health Professions Education, Maastricht University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands.
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.
| | - Bas C T van Bussel
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
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15
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Comparing the 4C mortality score for COVID-19 to established scores (CURB65, CRB65, qSOFA, NEWS) for respiratory infection patients. J Infect 2020; 82:414-451. [PMID: 33115655 PMCID: PMC7585728 DOI: 10.1016/j.jinf.2020.10.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
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16
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Carriel J, Muñoz-Jaramillo R, Bolaños-Ladinez O, Heredia-Villacreses F, Menéndez-Sanchón J, Martin-Delgado J. [CURB-65 as a predictor of 30-day mortality in patients hospitalized with COVID-19 in Ecuador: COVID-EC StudyAbstract]. Rev Clin Esp 2020; 222:37-41. [PMID: 33110273 PMCID: PMC7580560 DOI: 10.1016/j.rce.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/14/2020] [Indexed: 11/23/2022]
Abstract
Objetivo Valorar la utilidad del CURB-65 para predecir la mortalidad a 30 días en pacientes adultos hospitalizados con COVID-19. Métodos Cohorte realizada entre el 1 de marzo y el 30 de abril de 2020 en Ecuador. Resultados Se incluyeron 247 pacientes (edad media 60 ± 14 años, 70% varones, mortalidad global 41,3%). Los pacientes con CURB-65 ≥ 2 presentaron mayor mortalidad (57 vs. 17%, p < 0,001), en asociación con otros marcadores de riesgo: edad avanzada, hipertensión arterial, sobrepeso/obesidad, fracaso renal, hipoxemia, requerimiento de ventilación mecánica o desarrollo de distrés respiratorio. Conclusiones En el análisis univariado (Kaplan-Meier) y multivariado (regresión de Cox) el CURB-65 ≥ 2 se relacionó con una mayor mortalidad a 30 días.
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Affiliation(s)
- J Carriel
- S. de Medicina Interna. Hospital Universitario La Zarzuela, Madrid, España
| | | | - O Bolaños-Ladinez
- S. de Medicina intensiva. S. de Cardiología. Hospital Clínica San Francisco, Guayaquil, Ecuador
| | - F Heredia-Villacreses
- S. de Medicina intensiva. S. de Cardiología. Hospital Clínica San Francisco, Guayaquil, Ecuador
| | | | - J Martin-Delgado
- Grupo de Investigación Atenea, Fundación para el Fomento de la Investigación Sanitaria y Biomédica, San Juan de Alicante, España
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17
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Holten AR, Nore KG, Tveiten CEVWK, Olasveengen TM, Tonby K. Predicting severe COVID-19 in the Emergency Department. Resusc Plus 2020; 4:100042. [PMID: 33403367 PMCID: PMC7577659 DOI: 10.1016/j.resplu.2020.100042] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/28/2020] [Accepted: 10/16/2020] [Indexed: 12/15/2022] Open
Abstract
Background COVID-19 may lead to severe disease, requiring intensive care treatment and challenging the capacity of health care systems. The aim of this study was to compare the ability of commonly used scoring systems for sepsis and pneumonia to predict severe COVID-19 in the emergency department. Methods Prospective, observational, single centre study in a secondary/tertiary care hospital in Oslo, Norway. Patients were assessed upon hospital admission using the following scoring systems; quick Sequential Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome criteria (SIRS), National Early Warning Score 2 (NEWS2), CURB-65 and Pneumonia Severity index (PSI). The ratio of arterial oxygen tension to inspiratory oxygen fraction (P/F-ratio) was also calculated. The area under the receiver operating characteristics curve (AUROC) for each scoring system was calculated, along with sensitivity and specificity for the most commonly used cut-offs. Severe disease was defined as death or treatment in ICU within 14 days. Results 38 of 175 study participants developed severe disease, 13 (7%) died and 29 (17%) had a stay at an intensive care unit (ICU). NEWS2 displayed an AUROC of 0.80 (95% confidence interval 0.72-0.88), CURB-65 0.75 (0.65-0.84), PSI 0.75 (0.65-0.84), SIRS 0.70 (0.61-0.80) and qSOFA 0.70 (0.61-0.79). NEWS2 was significantly better than SIRS and qSOFA in predicating severe disease, and with a cut-off of5 points, had a sensitivity and specificity of 82% and 60%, respectively. Conclusion NEWS2 predicted severe COVID-19 disease more accurately than SIRS and qSOFA, but not significantly better than CURB65 and PSI. NEWS2 may be a useful screening tool in evaluating COVID-19 patients during hospital admission. Trial registration : ClinicalTrials.gov Identifier: NCT04345536. (https://clinicaltrials.gov/ct2/show/NCT04345536).
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Affiliation(s)
- Aleksander Rygh Holten
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Corresponding author at: Oslo universitetssykehus HF, Ullevål sykehus, Postboks 4956 Nydalen 0424, Oslo, Norway.
| | - Kristin Grotle Nore
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | | | - Theresa Mariero Olasveengen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Kristian Tonby
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
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18
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Côté A, Ternacle J, Pibarot P. Early prediction of the risk of severe coronavirus disease 2019: A key step in therapeutic decision making. EBioMedicine 2020; 59:102948. [PMID: 32810827 PMCID: PMC7428762 DOI: 10.1016/j.ebiom.2020.102948] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/28/2020] [Indexed: 01/19/2023] Open
Affiliation(s)
- Andréanne Côté
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec G1V-4G5, Canada
| | - Julien Ternacle
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec G1V-4G5, Canada
| | - Philippe Pibarot
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec G1V-4G5, Canada.
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Prediction of respiratory decompensation in Covid-19 patients using machine learning: The READY trial. Comput Biol Med 2020; 124:103949. [PMID: 32798922 PMCID: PMC7410013 DOI: 10.1016/j.compbiomed.2020.103949] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 12/22/2022]
Abstract
Background Currently, physicians are limited in their ability to provide an accurate prognosis for COVID-19 positive patients. Existing scoring systems have been ineffective for identifying patient decompensation. Machine learning (ML) may offer an alternative strategy. A prospectively validated method to predict the need for ventilation in COVID-19 patients is essential to help triage patients, allocate resources, and prevent emergency intubations and their associated risks. Methods In a multicenter clinical trial, we evaluated the performance of a machine learning algorithm for prediction of invasive mechanical ventilation of COVID-19 patients within 24 h of an initial encounter. We enrolled patients with a COVID-19 diagnosis who were admitted to five United States health systems between March 24 and May 4, 2020. Results 197 patients were enrolled in the REspirAtory Decompensation and model for the triage of covid-19 patients: a prospective studY (READY) clinical trial. The algorithm had a higher diagnostic odds ratio (DOR, 12.58) for predicting ventilation than a comparator early warning system, the Modified Early Warning Score (MEWS). The algorithm also achieved significantly higher sensitivity (0.90) than MEWS, which achieved a sensitivity of 0.78, while maintaining a higher specificity (p < 0.05). Conclusions In the first clinical trial of a machine learning algorithm for ventilation needs among COVID-19 patients, the algorithm demonstrated accurate prediction of the need for mechanical ventilation within 24 h. This algorithm may help care teams effectively triage patients and allocate resources. Further, the algorithm is capable of accurately identifying 16% more patients than a widely used scoring system while minimizing false positive results. Validation of prediction algorithm for ventilation requirements in COVID-19 patients. Algorithm achieved significantly higher sensitivity than the common scoring system MEWS. Algorithm detected 16% more patients who will require invasive ventilation than MEWS. Advance warning of ventilation needs can help improve COVID-19 patient outcomes.
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Fu EL, Janse RJ, de Jong Y, van der Endt VHW, Milders J, van der Willik EM, de Rooij ENM, Dekkers OM, Rotmans JI, van Diepen M. Acute kidney injury and kidney replacement therapy in COVID-19: a systematic review and meta-analysis. Clin Kidney J 2020; 13:550-563. [PMID: 32897278 PMCID: PMC7467593 DOI: 10.1093/ckj/sfaa160] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) can affect hospitalized patients with coronavirus disease 2019 (COVID-19), with estimates ranging between 0.5% and 40%. We performed a systematic review and meta-analysis of studies reporting incidence, mortality and risk factors for AKI in hospitalized COVID-19 patients. METHODS We systematically searched 11 electronic databases until 29 May 2020 for studies in English reporting original data on AKI and kidney replacement therapy (KRT) in hospitalized COVID-19 patients. Incidences of AKI and KRT and risk ratios for mortality associated with AKI were pooled using generalized linear mixed and random-effects models. Potential risk factors for AKI were assessed using meta-regression. Incidences were stratified by geographic location and disease severity. RESULTS A total of 3042 articles were identified, of which 142 studies were included, with 49 048 hospitalized COVID-19 patients including 5152 AKI events. The risk of bias of included studies was generally low. The pooled incidence of AKI was 28.6% [95% confidence interval (CI) 19.8-39.5] among hospitalized COVID-19 patients from the USA and Europe (20 studies) and 5.5% (95% CI 4.1-7.4) among patients from China (62 studies), whereas the pooled incidence of KRT was 7.7% (95% CI 5.1-11.4; 18 studies) and 2.2% (95% CI 1.5-3.3; 52 studies), respectively. Among patients admitted to the intensive care unit, the incidence of KRT was 20.6% (95% CI 15.7-26.7; 38 studies). Meta-regression analyses showed that age, male sex, cardiovascular disease, diabetes mellitus, hypertension and chronic kidney disease were associated with the occurrence of AKI; in itself, AKI was associated with an increased risk of mortality, with a pooled risk ratio of 4.6 (95% CI 3.3-6.5). CONCLUSIONS AKI and KRT are common events in hospitalized COVID-19 patients, with estimates varying across geographic locations. Additional studies are needed to better understand the underlying mechanisms and optimal treatment of AKI in these patients.
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Affiliation(s)
- Edouard L Fu
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roemer J Janse
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ype de Jong
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Vera H W van der Endt
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jet Milders
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Esmee M van der Willik
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther N M de Rooij
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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21
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Bar S, Lecourtois A, Diouf M, Goldberg E, Bourbon C, Arnaud E, Domisse L, Dupont H, Gosset P. The association of lung ultrasound images with COVID-19 infection in an emergency room cohort. Anaesthesia 2020; 75:1620-1625. [PMID: 32520406 PMCID: PMC7300460 DOI: 10.1111/anae.15175] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 12/16/2022]
Abstract
Lung ultrasound could facilitate the triage of patients with suspected COVID‐19 infection admitted to the emergency room. We developed a predictive model for COVID‐19 diagnosis based on lung ultrasound and clinical features. We used ultrasound to image the lung bilaterally at two anterior sites, one and two hands below each clavicle, and a posterolateral site that was the posterior transverse continuation from the lower anterior site. We studied 100 patients, 31 of whom had a COVID‐19 positive reverse transcriptase polymerase chain reaction. A positive test was independently associated with: quick sequential organ failure assessment score ≥1; ≥3 B‐lines at the upper site; consolidation and thickened pleura at the lower site; and thickened pleura line at the posterolateral site. The model discrimination was an area (95%CI) under the receiver operating characteristic curve of 0.82 (0.75–0.90). The characteristics (95%CI) of the model’s diagnostic threshold, applied to the population from which it was derived, were: sensitivity, 97% (83–100%); specificity, 62% (50–74%); positive predictive value, 54% (41–98%); and negative predictive value, 98% (88–99%). This model may facilitate triage of patients with suspected COVID‐19 infection admitted to the emergency room.
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Affiliation(s)
- S Bar
- Anaesthesiology and Critical Care Department, Amiens University Hospital, Amiens, France
| | - A Lecourtois
- Emergency Medicine Department, Amiens University Hospital, Amiens, France
| | - M Diouf
- Amiens University Hospital, Amiens, France
| | - E Goldberg
- Anaesthesiology and Critical Care Department, Amiens University Hospital, Amiens, France
| | - C Bourbon
- Emergency Medicine Department, Amiens University Hospital, Amiens, France
| | - E Arnaud
- Emergency Medicine Department, Amiens University Hospital, Amiens, France
| | - L Domisse
- Emergency Medicine Department, Amiens University Hospital, Amiens, France
| | - H Dupont
- Anaesthesiology and Critical Care Department, Amiens University Hospital, Amiens, France
| | - P Gosset
- Emergency Medicine Department, Amiens University Hospital, Amiens, France
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22
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Meylan S, Akrour R, Regina J, Bart PA, Dami F, Calandra T. An Early Warning Score to predict ICU admission in COVID-19 positive patients. J Infect 2020; 81:816-846. [PMID: 32474038 PMCID: PMC7263266 DOI: 10.1016/j.jinf.2020.05.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/23/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Sylvain Meylan
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Rachid Akrour
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean Regina
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre-Alexandre Bart
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Fabrice Dami
- Emergency department, Lausanne University Hospital, Switzerland
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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23
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Liu M, Gao Y, Shi S, Chen Y, Yang K, Tian J. Drinking no-links to the severity of COVID-19: a systematic review and meta-analysis. J Infect 2020; 81:e126-e127. [PMID: 32474047 PMCID: PMC7255718 DOI: 10.1016/j.jinf.2020.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Ming Liu
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Ya Gao
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Shuzhen Shi
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Yamin Chen
- School of Nursing, Lanzhou University, Lanzhou 730000, China
| | - Kelu Yang
- School of Nursing, Lanzhou University, Lanzhou 730000, China
| | - Jinhui Tian
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; School of Nursing, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China.
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