MuLBSTA skorunun şiddetli akut solunum sendromu koronavirüs 2019 pnömonili hospitalize hastalarda kritik klinik sonuçları öngörmedeki prediktif değerinin incelenmesi

Yıl 2022, Cilt: 27 Sayı: 3, 310 - 317, 27.09.2022

Serdar Yeşiltaş , Meliha Meriç Koç , Ayşe Karataş , Gülpınar Tepe , Ozge Pasin

https://doi.org/10.21673/anadoluklin.1132734

Öz

Amaç: Multilobar infiltrasyon, lenfositopeni, bakteriyel koenfeksiyon, sigara öyküsü, hipertansiyon ve yaş>65 (MuLBSTA) skoru, viral pnömonisi olan hastaları beklenen mortaliteye göre sınıflandırmak için kullanılan bir klinik tahmin kuralıdır. Hastanede yatan SARS-CoV-2 hastalarında kötü klinik sonuçlar için MuLBSTA’nın prediktif performansını PSI, CURB-65 ve qSOFA ile karşılaştırdık.

Yöntemler: Bu çalışma 11 Mart 2020 ile 31 Mayıs 2020 tarihleri arasında üçüncü basamak bir üniversite hastanesinde yatan SARS-CoV-2’li hastalar üzerinde geriye dönük yapıldı. SARS-CoV-2 testi pozitif çıkan 900 hastadan 271’i çalışmaya dâhil edildi. Tüm hastalarda 30 günlük mortalite, Yoğun bakım ünitesi (YBÜ) ihtiyacı, mekanik ventilasyon gereksinimi ve akut respiratuar distress (ARDS) gelişimini değerlendirmek için MuLBSTA, PSI, CURB-65 ve qSOFA skoru kullanıldı. Otuz günlük mortalite için prognostik faktörler de analiz edildi.

Bulgular: Hastanede yatan 271 hastanın 150’si (%55.3) erkekti. Ortalama yaş 54.2±15.4 yıldı. Otuz günlük ölüm oranı %10,7 idi. Çalışmaya dâhil edilen hastalardan; 39 hasta (%14,3) YBÜ’ye yatırıldı, 32 hasta (%11,8) mekanik ventilatör desteği aldı ve 23 hasta (%8,4) ARDS tanısı aldı. Mortaliteyi tahmin etmede MuLBSTA, PSI, CURB-65 ve qSOFA skorlarının eğri altında kalan alan (AUC) değerleri sırasıyla 0.877 (%95 CI 0.832 0.914), 0.853 (%95 CI 0.806-0.893), 0.769 (95% CI 0,714-0,817) ve 0,769 (95% CI 0,715-0,818). MuLBSTA puanı, diğer tahmin puanlarına kıyasla daha yüksek bir AUC değeri gösterdi. MuLBSTA ve PSI skorları, YBÜ ihtiyacı, mekanik ventilasyon gereksinimive ARDS gelişimi olan hastaları belirlemede CURB-65 ve qSOFA skorlarından daha iyi performans gösterdi.

Sonuç: MuLBSTA skoru, hastanede yatan SARS-CoV-2 hastalarında kötü klinik sonuçları tahmin etmek için etkili bir araçtır. Kullanımını doğrulamak için daha fazla çalışmaya ihtiyaç vardır.

Anahtar Kelimeler

COVID-19, COVID-19, erken uyarı skorları, MuLBSTA skoru, qSOFA

Destekleyen Kurum

Yoktur

Proje Numarası

Yoktur

Investigation of the predictive value of MuLBSTA score in predicting critical clinical outcomes in hospitalized patients with severe acute respiratory syndrome-coronavirus-2 pneumonia

Öz

Aim: Multilobar infiltration, lymphocytopenia, bacterial co-infection, smoking history, hypertension, and age>65 (MuLBSTA) score is a clinical prediction rule used to classify patients with viral pneumonia by expected mortality. We compared the predictive performance of MuLBSTA with PSI, CURB-65, and qSOFA for poor clinical outcomes in hospitalized severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) patients.

Methods: A retrospective study was conducted on patients with SARS-CoV-2 who were hospitalized in a tertiary medical center between March 11, 2020, and May 31, 2020. 271 out of 900 patients who tested positive for SARS-CoV-2 were included in the study. The MuLBSTA, PSI, CURB-65, and qSOFA scores were used to assess thirty-day mortality, need for intensive care unit (ICU), mechanical ventilation (MV) requirement, and development of acute respiratory distress syndrome (ARDS) in all patients. Prognostic factors were also analyzed for thirty-day mortality.

Results: Among all 271 hospitalized patients, 150 males (55.3%) were included. The mean age was 54.2±15.4 years. The 30-day mortality rate was 10.7%. Of the patients included in the study; 39 patients (14.3%) were admitted to the intensive care unit, 32 patients (11.8%) received mechanical ventilator support, and 23 patients (8.4%) were diagnosed with ARDS. In predicting mortality, the area under the curve (AUC) of the MuLBSTA, PSI, CURB-65 and qSOFA scores were 0.877 (95% CI 0,832 0,914), 0.853 (95% CI 0,806-0,893), 0.769 (95% CI 0,714-0,817) and 0.769 (95% CI 0,715-0,818), respectively. The MuLBSTA score showed a higher AUC value compared to other prediction scores. The MuLBSTA and PSI scores performed better than CURB-65 and qSOFA scores in determining patients’ need for ICU, MV requirement, and ARDS development.

Conclusion: The MuLBSTA score is an efficient tool to predict poor clinical outcomes in hospitalized patients with SARS-CoV-2. Further studies are warranted to validate its use.

Anahtar Kelimeler

COVID-19, early warning score, MuLBSTA score, qSOFA

Proje Numarası

Yoktur

Kaynakça

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