RESUMO
OBJECTIVE: To develop and validate a scoring system to predict mortality among hospitalized patients with COVID-19. METHODS: Retrospective cohort study. We analyzed 5,062 analyzed hospitalized patients with COVID-19 treated at two hospitals; one each in Quito and Guayaquil, from February to July 2020. We assessed predictors of mortality using survival analyses and Cox models. We randomly divided the database into two sets: (i) the derivation cohort (n = 2497) to identify predictors of mortality, and (ii) the validation cohort (n = 2565) to test the discriminative ability of a scoring system. After multivariate analyses, we used the final model's ß-coefficients to build the score. Statistical analyses involved the development of a Cox proportional hazards regression model, assessment of goodness of fit, discrimination, and calibration. RESULTS: There was a higher mortality risk for these factors: male sex [(hazard ratio (HR) = 1.32, 95% confidence interval (95% CI): 1.03-1.69], per each increase in a quartile of ages (HR = 1.44, 95% CI: 1.24-1.67) considering the younger group (17-44 years old) as the reference, presence of hypoxemia (HR = 1.40, 95% CI: 1.01-1.95), hypoglycemia and hospital hyperglycemia (HR = 1.99, 95% CI: 1.01-3.91, and HR = 1.27, 95% CI: 0.99-1.62, respectively) when compared with normoglycemia, an AST-ALT ratio >1 (HR = 1.55, 95% CI: 1.25-1.92), C-reactive protein level (CRP) of >10 mg/dL (HR = 1.49, 95% CI: 1.07-2.08), arterial pH <7.35 (HR = 1.39, 95% CI: 1.08-1.80) when compared with normal pH (7.35-7.45), and a white blood cell count >10 × 103 per µL (HR = 1.76, 95% CI: 1.35-2.29). We found a strong discriminative ability in the proposed score in the validation cohort [AUC of 0.876 (95% CI: 0.822-0.930)], moreover, a cutoff score ≥39 points demonstrates superior performance with a sensitivity of 93.10%, a specificity of 70.28%, and a correct classification rate of 72.66%. The LR+ (3.1328) and LR- (0.0981) values further support its efficacy in identifying high-risk patients. CONCLUSION: Male sex, increasing age, hypoxemia, hypoglycemia or hospital hyperglycemia, AST-ALT ratio >1, elevated CRP, altered arterial pH, and leucocytosis were factors significantly associated with higher mortality in hospitalized patients with COVID-19. A statistically significant Cox regression model with strong discriminatory power and good calibration was developed to predict mortality in hospitalized patients with COVID-19, highlighting its potential clinical utility.
Assuntos
COVID-19 , Hiperglicemia , Hipoglicemia , Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Estudos Retrospectivos , Equador/epidemiologia , Medição de Risco , Hospitais , Hipóxia , Fatores de RiscoRESUMO
La tuberculosis extrapulmonar se define como la infección ocasionada por Mycobacterium tuberculosis a tejidos y órganos fuera del parénquima pulmonar, aproximadamente el 1-3 % del total de los casos de TB son extrapulmonares y de estos el 11-16 % afectan al abdomen; 10 al 15 % en los no infectados por el VIH y hasta en 70 % en los infectados. El presente reporte es acerca de una paciente de 34 años, sexo femenino, heterosexual, que no refirió conductas sexuales de riesgo, misma que solicitó valoración por emergencias del hospital general del norte de Guayaquil Los Ceibos (HGNG-C), refiriendo manifestaciones clínicas de 1 semana de evolución aproximadamente, tales como: náusea, vómitos, deposiciones líquidas en varias ocasiones, sin mejoría a pesar de tratamiento médico previo, que se complica con la aparición de dolor abdominal severo, por el cual se decidió efectuar apendicetomía de emergencia; en los resultados anatomopatológicos se detectaron estructuras granulomatosas, estableciéndose el diagnóstico de tuberculosis extrapulmonar.
Extrapulmonary tuberculosis is defined as the infection caused by Mycobacterium tuberculosis to tissues and organs outside the lung parenchyma, approximately 1-3 % of the total TB cases are extrapulmonary and of these 11-16 % affect the abdomen; 10 to 15 % in those not infected by HIV and up to 70 % in those infected. The present report is about a 34-year-old female,heterosexual, who did not report risky sexual behavior, who requested emergency assessment from the general hospital in the north of Guayaquil Los Ceibos (HGNG-C), referring to manifestations clinics of 1 week of evolution, such as: nausea, vomiting, liquid stools on several occasions, without improvement despite previous medical treatment, which is complicated by the appearance of severe abdominal pain, for which it was decided to perform emergency appendectomy ; In the anatomopathological results, granulomatous structures were detected, establishing the diagnosis of extrapulmonary tuberculosis.