Artículo
Death risk stratification in elderly patients with covid-19. A comparative cohort study in nursing homes outbreaks
Autor/es | Bernabeu Wittel, Máximo
Ternero-Vega, J.E. Díaz-Jiménez, P. Conde Guzmán, Concepción Nieto Martín, María Dolores Moreno-Gaviño, L. Delgado-Cuesta, J. Ollero Baturone, Manuel |
Departamento | Universidad de Sevilla. Departamento de Medicina Universidad de Sevilla. CTS-636 Grupo de Investigación de Pacientes Pluripatológicos y con Enfermedades Avanzadas |
Fecha de publicación | 2020 |
Fecha de depósito | 2023-04-04 |
Publicado en |
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Resumen | Elderly people are more severely affected by COVID-19. Nevertheless scarce information about specific prognostic scores for this population is available. The main objective was to compare the accuracy of recently developed ... Elderly people are more severely affected by COVID-19. Nevertheless scarce information about specific prognostic scores for this population is available. The main objective was to compare the accuracy of recently developed COVID-19 prognostic scores to that of CURB-65, Charlson and PROFUND indices in a cohort of 272 elderly patients from four nursing homes, affected by COVID-19. Accuracy was measured by calibration (calibration curves and Hosmer-Lemeshov (H-L) test), and discriminative power (area under the receiver operation curve (AUC-ROC). Negative and positive predictive values (NPV and PPV) were also obtained. Overall mortality rate was 22.4 %. Only ACP and Shi et al. out of 10 specific COVID-19 indices could be assessed. All indices but CURB-65 showed a good calibration by H-L test, whilst PROFUND, ACP and CURB-65 showed best results in calibration curves. Only CURB-65 (AUC-ROC = 0.81 [0.75–0.87])) and PROFUND (AUC-ROC = 0.67 [0.6–0.75])) showed good discrimination power. The highest NPV was obtained by CURB-65 (95 % [90–98%]), PROFUND (93 % [77–98%]), and their combination (100 % [82–100%]); whereas CURB-65 (74 % [51–88%]), and its combination with PROFUND (80 % [50–94%]) showed highest PPV. PROFUND and CURB-65 indices showed the highest accuracy in predicting death-risk of elderly patients affected by COVID-19, whereas Charlson and recent developed COVID-19 specific tools lacked it, or were not available to assess. A comprehensive clinical stratification on two-level basis (basal death risk due to chronic conditions by PROFUND index, plus current death risk due to COVID-19 by CURB-65), could be an appropriate approach. |
Cita | Bernabeu Wittel, M., Ternero-Vega, J.E., Díaz-Jiménez, P., Conde Guzmán, C., Nieto Martín, M.D., Moreno-Gaviño, L.,...,Ollero Baturone, M. (2020). Death risk stratification in elderly patients with covid-19. A comparative cohort study in nursing homes outbreaks. Archives of Gerontology and Geriatrics, 91, 1-8. https://doi.org/10.1016/j.archger.2020.104240. |
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