简易体征评分系统对新冠患者严重程度和预后预测价值的多中心观察性研究

Predictive value of the simplified signs scoring system for the severity and prognosis of patients with COVID-19:A multicenter observational study

目的探究基于体征等指标建立的评分系统对新型冠状病毒感染(coronavirus disease 2019,COVID-19)患者预后的预测价值。方法回顾性分析四川省及湖北省45家医院2020年1月—5月1605例COVID-19确诊患者的临床资料。依据病情将患者分为轻症组[1150例,男508例,平均年龄(51.32±16.26)岁]和重症组[455例,男248例,平均年龄(57.63±16.16)岁]。结果重症组患者年龄、男性占比、就诊时呼吸频率、收缩压、平均动脉压大于或高于轻症组(P<0.05),外周血氧饱和度(peripheral oxygen saturation,SpO2)及格拉斯哥昏迷评分(Glasgow coma scale,GCS评分)低于轻症组(P<0.05);多因素logistic回归分析显示年龄、呼吸频率、SpO2、GCS评分为发生重症的独立危险因素。基于上述指标构建的评分系统预测重症患者的受试者工作特征曲线下面积为0.822,高于快速序贯器官衰竭评分(quick sequential organ failure assessment,qSOFA评分)及改良早期预警评分(modified early warning score,MEWS评分)(分别为0.629和0.631,P均<0.001);预测患者院内死亡的受试者工作特征曲线下面积为0.796,高于qSOFA及MEWS评分(分别为0.710和0.706,P均<0.001)。结论年龄、呼吸频率、SpO2、GCS评分为COVID-19患者病情严重程度的独立危险因素,基于此4项指标构建的预后评分系统可用于预测患者发生重症或早期死亡的风险。

Objective To explore the predictive value of a simplified signs scoring system for the severity and prognosis of patients with coronavirus disease 2019(COVID-19).Methods Clinical data of 1605 confirmed patients with COVID-19 from January to May 2020 in 45 hospitals of Sichuan and Hubei Provinces were retrospectively analyzed.The patients were divided into a mild group(n=1150,508 males,average age of 51.32±16.26 years)and a severe group(n=455,248 males,average age of 57.63±16.16 years).Results Age,male proportion,respiratory rate,systolic blood pressure and mean arterial pressure in the severe group were higher than those in the mild group(P<0.05).Peripheral oxygen saturation(SpO2)and Glasgow coma scale(GCS)were lower than those in the mild group(P<0.05).Multivariate logistic regression analysis showed that age,respiratory rate,SpO2,and GCS were independent risk factors for severe patients with COVID-19.Based on the above indicators,the receiver operating characteristic(ROC)curve analysis showed that the area under the curve of the simplified signs scoring system for predicting severe patients was 0.822,which was higher than that of the quick sequential organ failure assessment(qSOFA)score and modified early warning score(MEWS,0.629 and 0.631,P<0.001).The ROC analysis showed that the area under the curve of the simplified signs scoring system for predicting death was 0.796,higher than that of qSOFA score and MEWS score(0.710 and 0.706,P<0.001).Conclusion Age,respiratory rate,SpO2and GCS are independent risk factors for severe patients with COVID-19.The simplified signs scoring system based on these four indicators may be used to predict patient’s risk of severe illness or early death.