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PEGALUS: predictivity of elderly age, arterial gas analysis, and lung ultrasound. A new prognostic score for COVID-19 patients in the emergency department—an observational prospective study
BACKGROUND: Periodic surges of COVID-19 patients seeking care in the hospital environment overwhelm systems reduce the availability of resources for treatment of non-COVID-19 cases (Zheng et al. in J Hosp Infect 106:325–329, 2020). Hospital flow and resource management could be greatly enhanced by d...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9327975/ https://www.ncbi.nlm.nih.gov/pubmed/35895235 http://dx.doi.org/10.1007/s11739-022-03047-0 |
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author | Borio, Giorgia Tentori, Stefano Farolfi, Federica Suma, Gloria Vanessa Rienzo, Paola D’ambrosio, Annapaola Citro, Marta Antonini, Mariachiara Maffi, Paola |
author_facet | Borio, Giorgia Tentori, Stefano Farolfi, Federica Suma, Gloria Vanessa Rienzo, Paola D’ambrosio, Annapaola Citro, Marta Antonini, Mariachiara Maffi, Paola |
author_sort | Borio, Giorgia |
collection | PubMed |
description | BACKGROUND: Periodic surges of COVID-19 patients seeking care in the hospital environment overwhelm systems reduce the availability of resources for treatment of non-COVID-19 cases (Zheng et al. in J Hosp Infect 106:325–329, 2020). Hospital flow and resource management could be greatly enhanced by differentiating patients who are likely at risk of adverse clinical outcomes from those who could safely be discharged after evaluation and managed outside of the hospital setting (Sun et al. in J Infect Dis 223:38–46, 2021). Herein, we propose a prognostic score named PEGALUS (Predictivity of Elderly age, arterial blood Gas Analysis and Lung UltraSound) that could potentially help clinicians properly and rapidly choose the appropriate allocation of COVID-19 patients admitted to the emergency department (ED). METHODS: This observational prospective study enrolled COVID-19 patients who were admitted to the ED of IRCCS San Raffaele Hospital (HSR). RESULTS: 230 COVID-19 patients were enrolled and 30-day follow-up data was collected. Composite outcome was death or need for oro-tracheal intubation (OTI). 50 patients (21.5%) reached the outcome during the observational period. In multivariate Cox analysis, age, PO(2)/FiO(2) ratio, pCO(2), duration of symptoms, and lung ultrasound evaluation were significantly associated with the adverse outcome. We obtained a new scorecard (PEGALUS) according to the hazard ratio of the identified predictors. PEGALUS score performed well in predicting the composite outcome (AUC 0.866, 95% IC 0.812–0.921; p < 0.001). Kaplan–Meier showed that a PEGALUS score < 7 was associated with a good 30-day prognosis (survival rate 97.5%), compared to a PEGALUS score of 7–11 (survival rate 85.9%; p log-rank 0.009) and PEGALUS score > 11 (survival rate 49.3%; p log-rank < 0.001). CONCLUSIONS: PEGALUS score performed at the admission can predict adverse outcomes in patients with COVID-19. The systematic application of this score might permit a more accurate and rapid treatment allocation in this setting. |
format | Online Article Text |
id | pubmed-9327975 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-93279752022-07-28 PEGALUS: predictivity of elderly age, arterial gas analysis, and lung ultrasound. A new prognostic score for COVID-19 patients in the emergency department—an observational prospective study Borio, Giorgia Tentori, Stefano Farolfi, Federica Suma, Gloria Vanessa Rienzo, Paola D’ambrosio, Annapaola Citro, Marta Antonini, Mariachiara Maffi, Paola Intern Emerg Med EM - Original BACKGROUND: Periodic surges of COVID-19 patients seeking care in the hospital environment overwhelm systems reduce the availability of resources for treatment of non-COVID-19 cases (Zheng et al. in J Hosp Infect 106:325–329, 2020). Hospital flow and resource management could be greatly enhanced by differentiating patients who are likely at risk of adverse clinical outcomes from those who could safely be discharged after evaluation and managed outside of the hospital setting (Sun et al. in J Infect Dis 223:38–46, 2021). Herein, we propose a prognostic score named PEGALUS (Predictivity of Elderly age, arterial blood Gas Analysis and Lung UltraSound) that could potentially help clinicians properly and rapidly choose the appropriate allocation of COVID-19 patients admitted to the emergency department (ED). METHODS: This observational prospective study enrolled COVID-19 patients who were admitted to the ED of IRCCS San Raffaele Hospital (HSR). RESULTS: 230 COVID-19 patients were enrolled and 30-day follow-up data was collected. Composite outcome was death or need for oro-tracheal intubation (OTI). 50 patients (21.5%) reached the outcome during the observational period. In multivariate Cox analysis, age, PO(2)/FiO(2) ratio, pCO(2), duration of symptoms, and lung ultrasound evaluation were significantly associated with the adverse outcome. We obtained a new scorecard (PEGALUS) according to the hazard ratio of the identified predictors. PEGALUS score performed well in predicting the composite outcome (AUC 0.866, 95% IC 0.812–0.921; p < 0.001). Kaplan–Meier showed that a PEGALUS score < 7 was associated with a good 30-day prognosis (survival rate 97.5%), compared to a PEGALUS score of 7–11 (survival rate 85.9%; p log-rank 0.009) and PEGALUS score > 11 (survival rate 49.3%; p log-rank < 0.001). CONCLUSIONS: PEGALUS score performed at the admission can predict adverse outcomes in patients with COVID-19. The systematic application of this score might permit a more accurate and rapid treatment allocation in this setting. Springer International Publishing 2022-07-27 2022 /pmc/articles/PMC9327975/ /pubmed/35895235 http://dx.doi.org/10.1007/s11739-022-03047-0 Text en © The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI) 2022 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. |
spellingShingle | EM - Original Borio, Giorgia Tentori, Stefano Farolfi, Federica Suma, Gloria Vanessa Rienzo, Paola D’ambrosio, Annapaola Citro, Marta Antonini, Mariachiara Maffi, Paola PEGALUS: predictivity of elderly age, arterial gas analysis, and lung ultrasound. A new prognostic score for COVID-19 patients in the emergency department—an observational prospective study |
title | PEGALUS: predictivity of elderly age, arterial gas analysis, and lung ultrasound. A new prognostic score for COVID-19 patients in the emergency department—an observational prospective study |
title_full | PEGALUS: predictivity of elderly age, arterial gas analysis, and lung ultrasound. A new prognostic score for COVID-19 patients in the emergency department—an observational prospective study |
title_fullStr | PEGALUS: predictivity of elderly age, arterial gas analysis, and lung ultrasound. A new prognostic score for COVID-19 patients in the emergency department—an observational prospective study |
title_full_unstemmed | PEGALUS: predictivity of elderly age, arterial gas analysis, and lung ultrasound. A new prognostic score for COVID-19 patients in the emergency department—an observational prospective study |
title_short | PEGALUS: predictivity of elderly age, arterial gas analysis, and lung ultrasound. A new prognostic score for COVID-19 patients in the emergency department—an observational prospective study |
title_sort | pegalus: predictivity of elderly age, arterial gas analysis, and lung ultrasound. a new prognostic score for covid-19 patients in the emergency department—an observational prospective study |
topic | EM - Original |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9327975/ https://www.ncbi.nlm.nih.gov/pubmed/35895235 http://dx.doi.org/10.1007/s11739-022-03047-0 |
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