ABSTRACT
INTRODUCTION: Risk factors of adverse outcomes in COVID-19 are defined but stratification of mortality using non-laboratory measured scores, particularly at the time of prehospital SARS-CoV-2 testing, is lacking. METHODS: Multivariate regression with bootstrapping was used to identify independent mortality predictors in patients admitted to an acute hospital with a confirmed diagnosis of COVID-19. Predictions were externally validated in a large random sample of the ISARIC cohort (N=14 231) and a smaller cohort from Aintree (N=290). RESULTS: 983 patients (median age 70, IQR 53-83; in-hospital mortality 29.9%) were recruited over an 11-week study period. Through sequential modelling, a five-predictor score termed SOARS (SpO2, Obesity, Age, Respiratory rate, Stroke history) was developed to correlate COVID-19 severity across low, moderate and high strata of mortality risk. The score discriminated well for in-hospital death, with area under the receiver operating characteristic values of 0.82, 0.80 and 0.74 in the derivation, Aintree and ISARIC validation cohorts, respectively. Its predictive accuracy (calibration) in both external cohorts was consistently higher in patients with milder disease (SOARS 0-1), the same individuals who could be identified for safe outpatient monitoring. Prediction of a non-fatal outcome in this group was accompanied by high score sensitivity (99.2%) and negative predictive value (95.9%). CONCLUSION: The SOARS score uses constitutive and readily assessed individual characteristics to predict the risk of COVID-19 death. Deployment of the score could potentially inform clinical triage in preadmission settings where expedient and reliable decision-making is key. The resurgence of SARS-CoV-2 transmission provides an opportunity to further validate and update its performance.
Subject(s)
COVID-19/mortality , Hospital Mortality , Hospitalization/statistics & numerical data , Monitoring, Ambulatory/statistics & numerical data , Pneumonia, Viral/mortality , Aged , Aged, 80 and over , Decision Making , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/virology , Predictive Value of Tests , Prognosis , Risk Factors , SARS-CoV-2 , Severity of Illness IndexABSTRACT
A 55-year-old Indian man presented with productive cough and a large left pleural effusion. Pleural fluid culture grew Mycobacterium tuberculosis, and he was started on antituberculosis therapy. One week later, the patient presented to hospital with drowsiness, dehydration and hypotension. He was transferred to critical care and only improved after starting hydrocortisone and stopping rifampicin. His short synACTHen test subsequently confirmed primary adrenal insufficiency, and a CT of the abdomen showed bilateral adrenal enlargement. Rifampicin is known to accelerate cortisol metabolism. We report the rare case of a rifampicin-induced adrenal crisis as a first presentation of Addison's disease in a patient with tuberculous infiltration of the adrenal glands.
Subject(s)
Adrenal Glands/drug effects , Adrenal Insufficiency/chemically induced , Antitubercular Agents/adverse effects , Mycobacterium tuberculosis/isolation & purification , Pleural Effusion/microbiology , Rifampin/adverse effects , Tuberculosis, Pulmonary/drug therapy , Adrenal Glands/physiopathology , Antitubercular Agents/administration & dosage , Cough/microbiology , Dehydration , Humans , Hydrocortisone/therapeutic use , Hypotension , Male , Middle Aged , Pleural Effusion/complications , Rifampin/administration & dosage , Sleep Stages , Treatment Outcome , Tuberculosis, Pulmonary/physiopathologyABSTRACT
A case report of an interesting paraneoplastic syndrome http://ow.ly/YGAR3.
