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Predicción de mortalidad en COVID-19. Comparación entre dos escalas / COVID-19 mortality prediction. Comparison between two scales
Resumen
Resumen
Introducción: el pronóstico y mortalidad en pacientes con COVID-19 son variables. Las escalas NEWS2 (National Early Warning Score) y REMS (Rapid Emergency Medicine Score) pueden ser utilizadas rápidamente al ingreso hospitalario para predecir mortalidad, sin embargo no se encuentran estudios que comparen su rendimiento predictivo en nuestra población.
Objetivo: comparar las escalas NEWS2 y REMS para predecir mortalidad en pacientes con COVID-19.
Material y métodos: cohorte retrospectiva con 361 pacientes. Se recabaron las variables para calcular las escalas NEWS2 y REMS y el motivo de egreso hospitalario. El valor predictivo para mortalidad se analizó mediante curva COR, estableciendóse área bajo la curva (AUC) con intervalos de confianza al 95% (IC95%). Se determinó el punto de corte (PC) con la mejor sensibilidad y especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN), además de riesgo relativo (RR) con IC95%.
Resultados: las AUC de NEWS2 y REMS fueron de 0.929 (IC95%: 0.903 - 0.956) y 0.913 (IC95%: 0.884 - 0.943), respectivamente. El PC de la escala NEWS2 fue de 8 puntos, con sensibilidad de 87.8% y especificidad de 82.1%, el VPP de 69.7% y el VPN de 93.5%; mientras que de la escala REMS fue de 7 puntos, con sensibilidad de 83.5% y especificidad de 83.7%, el VPP de 70.5% y el VPN de 91.6%. Un total de 8 o más puntos en la escala NEWS2 presentan un RR de 10.74 (IC95%: 6.4 - 18.03), y REMS de 7 o más puntos un RR de 8.36 (IC95%: 5.36 - 13.02)
Conclusión: ambas pruebas presentaron buena capacidad discriminativa para predecir mortalidad, siendo mejor de acuerdo con AUC y RR en la escala NEWS2.
Abstract
Background: The prognosis and mortality in patients with COVID-19 are variable. The NEWS2 (National Early Warning Score) and REMS (Rapid Emergency Medicine Score) scales can be used quickly at hospital admission to predict mortality, no studies have been found that compare their predictive performance in our population.
Objective: To compare NEWS2 and REMS to predict mortality in patients with COVID-19.
Material and methods: Retrospective cohort with 361 patients. The variables were collected to calculate the NEWS2 and REMS scales and the reason for hospital discharge. The predictive value for mortality was analyzed using the ROC curve, establishing the area under the curve (AUC) with 95% confidence intervals (95% CI). The cut-off point (PC) with the best sensitivity and specificity, positive predictive value (PPV) and negative predictive value (NPV), as well as relative risk (RR) with 95% CI.
Results: The AUC of NEWS2 and REMS were 0.929 (95% CI: 0.903-0.956) and 0.913 (95% CI: 0.884-0.943), respectively. The PC of the NEWS2 scale was 8 points, with sensitivity 87.8% and specificity 82.1%, PPV 69.7% and NPV 93.5% and of the REMS scale of 7 points, with sensitivity 83.5% and specificity 83.7%, PPV 70.5% and NPV 91.6%. 8 or more points on the NEWS2 scale presenting a RR of 10.74 (95% CI: 6.4-18.03), and REMS 7 or more points RR 8.36 (95% CI: 5.36-13.02)
Conclusion: Both tests presented good discriminative ability to predict mortality, being better according to AUC and RR in the NEWS2 scale.
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