tetano
Editor, Senior Moderator
J Clin Med
. 2021 Jun 17;10(12):2672.
doi: 10.3390/jcm10122672.
Direct Comparison of Clinical Characteristics, Outcomes, and Risk Prediction in Patients with COVID-19 and Controls-A Prospective Cohort Study
Maurin Lampart[SUP] 1 [/SUP], Marco Rüegg[SUP] 2 [/SUP], Andrea S Jauslin[SUP] 2 [/SUP], Noemi R Simon[SUP] 2 [/SUP], Núria Zellweger[SUP] 3 [/SUP], Ceylan Eken[SUP] 1 [/SUP], Sarah Tschudin-Sutter[SUP] 4 [/SUP], Stefano Bassetti[SUP] 5 [/SUP], Katharina M Rentsch[SUP] 6 [/SUP], Martin Siegemund[SUP] 3 7 [/SUP], Roland Bingisser[SUP] 2 [/SUP], Christian H Nickel[SUP] 2 [/SUP], Stefan Osswald[SUP] 1 [/SUP], Gabriela M Kuster[SUP] 1 [/SUP], Raphael Tweenhood[SUP] 1 8 [/SUP]
Affiliations
Abstract
Most studies investigating early risk predictors in coronavirus disease 19 (COVID-19) lacked comparison with controls. We aimed to assess and directly compare outcomes and risk predictors at time of emergency department (ED) presentation in COVID-19 and controls. Consecutive patients presenting to the ED with suspected COVID-19 were prospectively enrolled. COVID-19-patients were compared with (i) patients tested negative (overall controls) and (ii) patients tested negative, who had a respiratory infection (respiratory controls). Primary outcome was the composite of intensive care unit (ICU) admission and death at 30 days. Among 1081 consecutive cases, 191 (18%) were tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 890 (82%) were tested negative (overall controls), of which 323 (30%) had a respiratory infection (respiratory controls). Incidence of the composite outcome was significantly higher in COVID-19 (23%) as compared with the overall control group (10%, adjusted-HR 2.45 (95%CI, 1.61-3.74), p < 0.001) or the respiratory control group (10%, adjusted-HR 2.93 (95%CI, 1.66-5.17), p < 0.001). Blood oxygen saturation, age, high-sensitivity troponin, c-reactive protein, and lactate dehydrogenase were identified as the strongest predictors of poor outcome available at time of ED presentation in COVID-19 with highly comparable prognostic utility in overall and respiratory controls. In conclusion, patients presenting to the ED with COVID-19 have a worse outcome than controls, even after adjustment for differences in baseline characteristics. Most predictors of poor outcome in COVID-19 were not restricted to COVID-19, but of comparable prognostic utility in controls and therefore generalizable to unselected patients with suspected COVID-19.
Keywords: COVID-19; SARS-CoV-2; characteristics; comparison; controls; outcome; risk prediction.
. 2021 Jun 17;10(12):2672.
doi: 10.3390/jcm10122672.
Direct Comparison of Clinical Characteristics, Outcomes, and Risk Prediction in Patients with COVID-19 and Controls-A Prospective Cohort Study
Maurin Lampart[SUP] 1 [/SUP], Marco Rüegg[SUP] 2 [/SUP], Andrea S Jauslin[SUP] 2 [/SUP], Noemi R Simon[SUP] 2 [/SUP], Núria Zellweger[SUP] 3 [/SUP], Ceylan Eken[SUP] 1 [/SUP], Sarah Tschudin-Sutter[SUP] 4 [/SUP], Stefano Bassetti[SUP] 5 [/SUP], Katharina M Rentsch[SUP] 6 [/SUP], Martin Siegemund[SUP] 3 7 [/SUP], Roland Bingisser[SUP] 2 [/SUP], Christian H Nickel[SUP] 2 [/SUP], Stefan Osswald[SUP] 1 [/SUP], Gabriela M Kuster[SUP] 1 [/SUP], Raphael Tweenhood[SUP] 1 8 [/SUP]
Affiliations
- PMID: 34204453
- DOI: 10.3390/jcm10122672
Abstract
Most studies investigating early risk predictors in coronavirus disease 19 (COVID-19) lacked comparison with controls. We aimed to assess and directly compare outcomes and risk predictors at time of emergency department (ED) presentation in COVID-19 and controls. Consecutive patients presenting to the ED with suspected COVID-19 were prospectively enrolled. COVID-19-patients were compared with (i) patients tested negative (overall controls) and (ii) patients tested negative, who had a respiratory infection (respiratory controls). Primary outcome was the composite of intensive care unit (ICU) admission and death at 30 days. Among 1081 consecutive cases, 191 (18%) were tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 890 (82%) were tested negative (overall controls), of which 323 (30%) had a respiratory infection (respiratory controls). Incidence of the composite outcome was significantly higher in COVID-19 (23%) as compared with the overall control group (10%, adjusted-HR 2.45 (95%CI, 1.61-3.74), p < 0.001) or the respiratory control group (10%, adjusted-HR 2.93 (95%CI, 1.66-5.17), p < 0.001). Blood oxygen saturation, age, high-sensitivity troponin, c-reactive protein, and lactate dehydrogenase were identified as the strongest predictors of poor outcome available at time of ED presentation in COVID-19 with highly comparable prognostic utility in overall and respiratory controls. In conclusion, patients presenting to the ED with COVID-19 have a worse outcome than controls, even after adjustment for differences in baseline characteristics. Most predictors of poor outcome in COVID-19 were not restricted to COVID-19, but of comparable prognostic utility in controls and therefore generalizable to unselected patients with suspected COVID-19.
Keywords: COVID-19; SARS-CoV-2; characteristics; comparison; controls; outcome; risk prediction.