학술논문
The COVID‐19 Worsening Score (COWS)—a predictive bedside tool for critical illness.
Document Type
Article
Author
Boero, Enrico; Rovida, Serena; Schreiber, Annia; Berchialla, Paola; Charrier, Lorena; Cravino, Marta Maria; Converso, Marcella; Gollini, Paola; Puppo, Mattia; Gravina, Angela; Fornelli, Giorgia; Labarile, Giulia; Sciacca, Santi; Bove, Tiziana; Karakitsos, Dimitrios; Aprà, Franco; Blaivas, Michael; Vetrugno, Luigi
Source
Subject
*PREDICTIVE tests
*COVID-19
*HOSPITAL emergency services
*CONFIDENCE intervals
*LUNGS
*RESEARCH methodology
*IDENTIFICATION
*RETROSPECTIVE studies
*PATIENTS
*CATASTROPHIC illness
*DESCRIPTIVE statistics
*ODDS ratio
*RECEIVER operating characteristic curves
*LONGITUDINAL method
*DISEASE risk factors
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Language
ISSN
0742-2822
Abstract
Objectives: To evaluate the accuracy of a new COVID‐19 prognostic score based on lung ultrasound (LUS) and previously validated variables in predicting critical illness. Methods: We conducted a single‐center retrospective cohort development and internal validation study of the COVID‐19 Worsening Score (COWS), based on a combination of the previously validated COVID‐GRAM score (GRAM) variables and LUS. Adult COVID‐19 patients admitted to the emergency department (ED) were enrolled. Ten variables previously identified by GRAM, days from symptom onset, LUS findings, and peripheral oxygen saturation/fraction of inspired oxygen (P/F) ratio were analyzed. LUS score as a single predictor was assessed. We evaluated GRAM model's performance, the impact of adding LUS, and then developed a new model based on the most predictive variables. Results: Among 274 COVID‐19 patients enrolled, 174 developed critical illness. The GRAM score identified 51 patients at high risk of developing critical illness and 132 at low risk. LUS score over 15 (range 0 to 36) was associated with a higher risk ratio of critical illness (RR, 2.05; 95% confidence interval [CI], 1.52‐2.77; area under the curve [AUC], 0.63; 95% CI 0.676‐0.634). The newly developed COVID‐19 Worsening Score relies on five variables to classify high‐ and low‐risk patients with an overall accuracy of 80% and negative predictive value of 93% (95% CI, 87%‐98%). Patients scoring more than 0.183 on COWS showed a RR of developing critical illness of 8.07 (95% CI, 4.97‐11.1). Conclusions: COWS accurately identify patients who are unlikely to need intensive care unit (ICU) admission, preserving resources for the remaining high‐risk patients. [ABSTRACT FROM AUTHOR]