ABSTRACT
BACKGROUND: This work aims to identify and validate a risk scale for admission to intensive care units (ICU) in hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS: We created a derivation rule and a validation rule for ICU admission using data from a national registry of a cohort of patients with confirmed SARS-CoV-2 infection who were admitted between March and August 2020 (N = 16,298). We analyzed the available demographic, clinical, radiological, and laboratory variables recorded at hospital admission. We evaluated the performance of the risk score by estimating the area under the receiver operating characteristic curve (AUROC). Using the ß coefficients of the regression model, we developed a score (0-100 points) associated with ICU admission. RESULTS: The mean age of the patients was 67 years; 57% were men. A total of 1420 (8.7%) patients were admitted to the ICU. The variables independently associated with ICU admission were age, dyspnea, Charlson Comorbidity Index score, neutrophil-to-lymphocyte ratio, lactate dehydrogenase levels, and presence of diffuse infiltrates on a chest X-ray. The model showed an AUROC of 0.780 (CI: 0.763-0.797) in the derivation cohort and an AUROC of 0.734 (CI: 0.708-0.761) in the validation cohort. A score of greater than 75 points was associated with a more than 30% probability of ICU admission while a score of less than 50 points reduced the likelihood of ICU admission to 15%. CONCLUSION: A simple prediction score was a useful tool for forecasting the probability of ICU admission with a high degree of precision.
Subject(s)
COVID-19 , Aged , Hospitalization , Humans , Intensive Care Units , Male , Retrospective Studies , Risk Factors , SARS-CoV-2ABSTRACT
Background and Aims: Acute respiratory infections can trigger acute myocardial infarction. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes an endotheliopathy that leads to some patients to thrombotic microangiopathy and microcirculatory impairment. We evaluated the association between laboratory-confirmed SARS-CoV-2 disease and the incidence of myocardial infarction. Also, we assessed the management of acute myocardial infarction during the COVID-19 pandemic. Methods: We compared the incidence of acute myocardial infarction (CIE 10: I21) between March 1st and May 31st in the years 2019 and 2020 in a 280-bed University Affiliated Hospital in Eastern Spain. To evaluate the association between laboratory-confirmed SARS-CoV-2 infection and hospitalization for acute myocardial infarction we defined the “risk interval” as the first seven days after respiratory specimen collection. We compared patients and procedural characteristics before or after COVID-19. Results: In 2019, we recorded 50 patients with acute myocardial infarction among 3261 adult hospitalizations (incidence rate of 1.53 per 100 admissions;95% CI: 1.15-2.00). In 2020, we recorded 35 patients with acute myocardial infarction among 2268 adult hospitalizations (incidence rate of 1.54 per 100 admissions;95% CI 1.09-2.12) (P= 0.97). Only 1 (0.4%) out of 245 patients with confirmed SARS-CoV-2 infection had an acute myocardial infarction. We found an increase in time from symptoms onset to reperfusion time in the COVID-19 period. Conclusions: We did not find a significant association between SARS-CoV-2 infection and acute myocardial infarction. Nevertheless, procedural characteristics were affected during the COVID-19 period.
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