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10.1007/s11606-020-06353-5

http://scihub22266oqcxt.onion/10.1007/s11606-020-06353-5
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33274414!7713904!33274414
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suck abstract from ncbi


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pmid33274414      J+Gen+Intern+Med 2021 ; 36 (3): 730-737
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  • Derivation of a Clinical Risk Score to Predict 14-Day Occurrence of Hypoxia, ICU Admission, and Death Among Patients with Coronavirus Disease 2019 #MMPMID33274414
  • Levine DM; Lipsitz SR; Co Z; Song W; Dykes PC; Samal L
  • J Gen Intern Med 2021[Mar]; 36 (3): 730-737 PMID33274414show ga
  • BACKGROUND: Uncertainty surrounding COVID-19 regarding rapid progression to acute respiratory distress syndrome and unusual clinical characteristics make discharge from a monitored setting challenging. A clinical risk score to predict 14-day occurrence of hypoxia, ICU admission, and death is unavailable. OBJECTIVE: Derive and validate a risk score to predict suitability for discharge from a monitored setting among an early cohort of patients with COVID-19. DESIGN: Model derivation and validation in a retrospective cohort. We built a manual forward stepwise logistic regression model to identify variables associated with suitability for discharge and assigned points to each variable. Event-free patients were included after at least 14 days of follow-up. PARTICIPANTS: All adult patients with a COVID-19 diagnosis between March 1, 2020, and April 12, 2020, in 10 hospitals in Massachusetts, USA. MAIN MEASURES: Fourteen-day composite predicting hypoxia, ICU admission, and death. We calculated a risk score for each patient as a predictor of suitability for discharge evaluated by area under the curve. KEY RESULTS: Of 2059 patients with COVID-19, 1326 met inclusion. The 1014-patient training cohort had a mean age of 58 years, was 56% female, and 65% had at least one comorbidity. A total of 255 (25%) patients were suitable for discharge. Variables associated with suitability for discharge were age, oxygen saturation, and albumin level, yielding a risk score between 0 and 55. At a cut point of 30, the score had a sensitivity of 83% and specificity of 82%. The respective c-statistic for the derivation and validation cohorts were 0.8939 (95% CI, 0.8687 to 0.9192) and 0.8685 (95% CI, 0.8095 to 0.9275). The score performed similarly for inpatients and emergency department patients. CONCLUSIONS: A 3-item risk score for patients with COVID-19 consisting of age, oxygen saturation, and an acute phase reactant (albumin) using point of care data predicts suitability for discharge and may optimize scarce resources.
  • |Adult[MESH]
  • |Aged[MESH]
  • |COVID-19 Testing/*statistics & numerical data[MESH]
  • |COVID-19/*mortality/therapy[MESH]
  • |Female[MESH]
  • |Humans[MESH]
  • |Hypoxia/*mortality[MESH]
  • |Intensive Care Units/*statistics & numerical data[MESH]
  • |Male[MESH]
  • |Middle Aged[MESH]
  • |Respiration, Artificial/*mortality[MESH]
  • |Respiratory Insufficiency/*mortality[MESH]
  • |Retrospective Studies[MESH]
  • |Risk Assessment[MESH]


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