Nomogramm zur Risikostratifizierung von COVID-19-Patienten mit interstitieller Pneumonie in der Notaufnahme: Eine retrospektive multizentrische Studie

BACKGROUND: There is currently no reliable method to identify which COVID-19 patients in the emergency department will experience rapid disease progression and death. AIM: The aim of this work is to investigate predictive risk factors for 30-day mortality in COVID-19 (coronavirus disease 2019) patients with interstitial pneumonia using patient history, and clinical and laboratory parameters and to develop a nomogram for risk stratification in the emergency department. METHODS: A retrospective, multicenter study was conducted in a cohort of 164 patients with COVID-19 pneumonia in the emergency departments of hospitals in Merano and Bressanone from 1 March 2020 to 31 March 2020. Patients were diagnosed as positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using fluorescence reverse transcription polymerase chain reaction (RT-PCR). A nomogram for risk stratification of 30-day mortality of COVID-19 patients was developed based on the parameters studied. RESULTS: In all, 35 (21.3%) of 164 COVID-19 patients with interstitial pneumonia died within 30 days of admission to the emergency department. Multivariate analysis method revealed that cognitive deterioration (odds ratio [OR]: 8.330; p = 0.004), lymphocytopenia (OR: 4.229; p = 0.049), renal function deterioration (OR: 4.841; p = 0.028), peripheral oxygen saturation < 93% (OR: 17.871; p = 0.002), age > 75 years (OR: 2.925; p = 0.032), elevated C‑reactive protein (OR: 6.504; p = 0.005), low monocyte count (OR: 0.504; p = 0.004), and comorbidity (OR 5.862; p = 0.019) were associated with 30-day mortality. Using these eight parameters, a nomogram was developed that showed good discrimination with an area under the ROC curve of 0.937. CONCLUSION: The initial evaluation of the patient history, and the clinical and laboratory data collected in the emergency department provides important prognostic information for risk stratification of COVID-19 patients in the emergency department and for early identification of patients with risk for critical disease course.