预后评分在预测COVID-19患者急诊手术后30天死亡率中的作用:一项回顾性队列研究

IF 1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL
S T Karna, R Gouroumourty, Z Ahmad, S Trivedi, P Thaware, P Singh
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引用次数: 2

摘要

背景:用预后评分进行风险评估虽然很重要,但在COVID-19感染的急诊外科患者中很少有研究。方法和材料:我们对2020年5月1日至2021年10月31日在我院急诊手术的COVID-19感染成人患者进行回顾性队列研究,以了解术后30天死亡率和预后评分的预测准确性。我们评估了人口统计学数据、预后风险评分(美国麻醉师学会物理分类(ASA-PS)、顺序器官衰竭评估(SOFA)、快速SOFA (qSOFA)、死亡率和发病率计数生理和手术严重程度评分(POSSUM)和朴茨茅斯-POSSUM (P-POSSUM)评分)、手术和麻醉因素。我们使用Clavien-Dindo量表评估术后发病率并记录30天死亡率。采用单因素Cox比例风险回归、受试者工作特征曲线(ROC)、约登指数和Hosmer- Lemeshow拟合优度模型评价预后评分与死亡率的相关性。结果:急诊手术治疗67例新冠肺炎患者,术后并发症发生率为33%,30天死亡率为19%。与qSOFA和ASA-PS IE/IIE阴性相比,qSOFA和ASAPS IIIE/ IIE阳性的死亡风险分别高出9.03倍和12.7倍(P <分别为0.001)。SOFA、POSSUM和P-POSSUM评分每增加一个单位,死亡风险分别增加50%、18%和17%。SOFA、POSSUM和P-POSSUM的AUCROC曲线在生存者和非生存者之间具有较好的区分性(AUC分别为0.8829、0.85和0.86)。结论:与POSSUM和P-POSSUM相比,SOFA评分对预测术后30天死亡率具有更高的敏感性。然而,由于没有非COVID-19患者作为对照组,因此无法确定COVID-19感染的实际风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Performance of prognostic scores in prediction of 30-day postoperative mortality in COVID-19 patients after emergency surgery: A retrospective cohort study.

Performance of prognostic scores in prediction of 30-day postoperative mortality in COVID-19 patients after emergency surgery: A retrospective cohort study.

Performance of prognostic scores in prediction of 30-day postoperative mortality in COVID-19 patients after emergency surgery: A retrospective cohort study.

Performance of prognostic scores in prediction of 30-day postoperative mortality in COVID-19 patients after emergency surgery: A retrospective cohort study.

Background: : Risk assessment with prognostic scoring, though important, is scarcely studied in emergency surgical patients with COVID-19 infection.

Methods and material: We conducted a retrospective cohort study on adult emergency surgical patients with COVID-19 infection in our institute from 1 May 2020 to 31 October 2021 to find the 30-day postoperative mortality and predictive accuracy of prognostic scores. We assessed the demographic data, prognostic risk scores (American Society of Anesthesiologists-Physical Classification (ASA-PS), Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scores), surgical and anesthetic factors. We assessed the postoperative morbidity using the Clavien-Dindo scale and recorded the 30-day mortality. Correlation of prognostic scores and mortality was evaluated using Univariate Cox proportional hazards regression, receiver operating characteristic curve (ROC), Youden's index and Hosmer- Lemeshow goodness of fit model.

Results: Emergency surgery was performed in 67 COVID-19 patients with postoperative complication and 30-day mortality rate of 33% and 19%, respectively. A positive qSOFA and ASAPS IIIE/IVE had a 9.03- and 12.7-times higher risk of mortality compared to a negative qSOFA and ASA-PS IE/IIE (P < 0.001), respectively. Every unit increase of SOFA, POSSUM and P-POSSUM scores was associated with a 50%, 18% and 17% higher risk of mortality, respectively. SOFA, POSSUM and P-POSSUM AUCROC curves showed good discrimination between survivors and non-survivors (AUC 0.8829, 0.85 and 0.86, respectively).

Conclusions: SOFA score has a higher sensitivity to predict 30-day postoperative mortality as compared to POSSUM and P-POSSUM. However, in absence of a control group of non-COVID-19 patients, actual risk attributable to COVID-19 infection could not be determined.

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来源期刊
Journal of Postgraduate Medicine
Journal of Postgraduate Medicine 医学-医学:内科
CiteScore
2.00
自引率
0.00%
发文量
76
审稿时长
40 weeks
期刊介绍: The journal will cover technical, clinical and bioengineering studies related to human well being including ethical and social issues. The journal gives preference to clinically oriented studies over experimental and animal studies. The Journal would publish peer-reviewed original research papers, case reports, systematic reviews, meta-analysis, and debates.
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