Your browser doesn't support javascript.
COVID-19 Time of Intubation Mortality Evaluation (C-TIME): A system for predicting mortality of patients with COVID-19 pneumonia at the time they require mechanical ventilation.
Raschke, Robert A; Rangan, Pooja; Agarwal, Sumit; Uppalapu, Suresh; Sher, Nehan; Curry, Steven C; Heise, C William.
  • Raschke RA; The Division of Clinical Data Analytics and Decision Support, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States of America.
  • Rangan P; University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States of America.
  • Agarwal S; University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States of America.
  • Uppalapu S; Department of Internal Medicine, Banner-University Medical Center Phoenix, Phoenix, AZ, United States of America.
  • Sher N; University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States of America.
  • Curry SC; Department of Internal Medicine, Banner-University Medical Center Phoenix, Phoenix, AZ, United States of America.
  • Heise CW; University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States of America.
PLoS One ; 17(7): e0270193, 2022.
Article in English | MEDLINE | ID: covidwho-1923708
ABSTRACT

BACKGROUND:

An accurate system to predict mortality in patients requiring intubation for COVID-19 could help to inform consent, frame family expectations and assist end-of-life decisions. RESEARCH

OBJECTIVE:

To develop and validate a mortality prediction system called C-TIME (COVID-19 Time of Intubation Mortality Evaluation) using variables available before intubation, determine its discriminant accuracy, and compare it to acute physiology and chronic health evaluation (APACHE IVa) and sequential organ failure assessment (SOFA).

METHODS:

A retrospective cohort was set in 18 medical-surgical ICUs, enrolling consecutive adults, positive by SARS-CoV 2 RNA by reverse transcriptase polymerase chain reaction or positive rapid antigen test, and undergoing endotracheal intubation. All were followed until hospital discharge or death. The combined outcome was hospital mortality or terminal extubation with hospice discharge. Twenty-five clinical and laboratory variables available 48 hours prior to intubation were entered into multiple logistic regression (MLR) and the resulting model was used to predict mortality of validation cohort patients. Area under the receiver operating curve (AUROC) was calculated for C-TIME, APACHE IVa and SOFA.

RESULTS:

The median age of the 2,440 study patients was 66 years; 61.6 percent were men, and 50.5 percent were Hispanic, Native American or African American. Age, gender, COPD, minimum mean arterial pressure, Glasgow Coma scale score, and PaO2/FiO2 ratio, maximum creatinine and bilirubin, receiving factor Xa inhibitors, days receiving non-invasive respiratory support and days receiving corticosteroids prior to intubation were significantly associated with the outcome variable. The validation cohort comprised 1,179 patients. C-TIME had the highest AUROC of 0.75 (95%CI 0.72-0.79), vs 0.67 (0.64-0.71) and 0.59 (0.55-0.62) for APACHE and SOFA, respectively (Chi2 P<0.0001).

CONCLUSIONS:

C-TIME is the only mortality prediction score specifically developed and validated for COVID-19 patients who require mechanical ventilation. It has acceptable discriminant accuracy and goodness-of-fit to assist decision-making just prior to intubation. The C-TIME mortality prediction calculator can be freely accessed on-line at https//phoenixmed.arizona.edu/ctime.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0270193

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0270193