Desempeño de las escalas QSOFA y QCSI en el servicio de urgencias para predecir mortalidad de los pacientes con COVID-19 del HGZ No. 2 de Aguascalientes

Abstract

RESUMEN “Desempeño de las escalas qSOFA y qCSI en el servicio de urgencias para predecir mortalidad de los pacientes con COVID-19 del HGZ No. 2 de Aguascalientes” Introducción. La pandemia por COVID-19 sigue vigente y ha evolucionado; pues siguen ingresando a los servicios de urgencias pacientes con esta enfermedad en formas moderadas, severas y graves. Entre otras, la vacunación a atenuado la severidad del cuadro clínico, por lo que es necesario evaluar si a estas alturas, escalas pronósticas siguen siendo buenos predictores de severidad y mortalidad por COVID-19. Objetivo. Evaluar el desempeño de las escalas qSOFA y qCSI en el servicio de urgencias para predecir mortalidad de los pacientes con COVID-19 del HGZ No.2 de Aguascalientes. Material y métodos: Se realizó un estudio observacional, transversal, analítico, retrospectivo e inferencial a partir de expedientes de pacientes que ingresaron al HGZ No. 2 del IMSS en Aguascalientes, durante el periodo de enero 2021 a enero 2022 por presentar COVID-19 moderado, severo o grave. Una vez aprobado el estudio por los Comités de Investigación y Bioética e Investigación, se identificaron los casos de pacientes que cumplieron criterios de selección y se solicitaron sus expedientes para obtener la siguiente información de interés: Edad, sexo, comorbilidades, severidad de COVID-19 (según la OMS), puntuaciones qSOFA, y QCSI, duración de la estancia hospitalaria y mortalidad. A partir de esta información se determinó si las puntuaciones qSOFA y QCSI son útiles para predecir COVID-19 severo-grave y mortalidad, mediante un análisis estadístico descriptivo e inferencial; que incluyó estimaciones de curvas ROC y regresión logística binaria. Una p<0.05 se consideró significativa. Resultados: Se incluyeron 122 pacientes (46.7% femeninos y 53.5% masculinos), de los cuales el 42.6% tenían enfermedad moderada y el 57.4% severa. La mortalidad en los pacientes con COVID-19 incluidos fue de 50%; en pacientes con COVID-19 moderado fue de 42.3% y en pacientes con COVID-19 severo 55.7%. La puntuación media qCSI en fallecidos y sobrevivientes fue 0.85±0.57 y 0.90±0.54 puntos, respectivamente (p=0.626); la puntuación media qSOFA fue 7.6±4.5 puntos y 6.7±4.6 (p=0.292). El área bajo la curva (AUC) de la puntuación qCSI fue 0.478 (IC95% 0.375-0.581, p=0.673) y para qSOFA fue 0.545 (IC95% 442-0.648, p=0.392). En el análisis multivariado las puntuaciones qCSI y qSOFA no fueron predictores independientes de mortalidad; solamente la edad se asoció significativamente con un ligero incremento en la mortalidad (ORa=1.022, IC95% 1.000-1.044, p=0.05). Conclusiones: Las escalas qSOFA y qCSI no fueron útiles para predecir mortalidad en pacientes con COVID-19 del HGZ No.2 de Aguascalientes. Por tanto, deberían buscarse otras escalas que tengan mayor precisión para predecir mortalidad e identificar pacientes que ameritan tratamiento agresivo. Palabras clave. qCSI, qSOFA, COVID-19, mortalidad

ABSTRACT “QSOFA AND QCSI SCALES PERFORMANCE IN THE E.R. WING TO PREDICT COVID-19 PACIENTS’ MORTALITY RATE AT HGZ #2 IN THE CITY OF AGUASCALIENTES, MEXICO¨. Introduction: The ongoing COVID-19 pandemic has evolved as new patients suffering from the disease still require the E.R services ranging from mild, severe or grave types. Among these circumstances, there exists the advantage that vaccination has brought toward the reduction in the severity of the patients’ medical condition which, at this point, the need to asses whether the predictive scales remain to be applicable to forecast the severity and mortality rates of said patients. Objective: To assess both qSOFA and qCSI performance in the E.R. service to predict the mortality rate on COVID-19 patients at HGZ #2 in the city of Aguascalientes. Methods and materials: An analytical, observational, retrospective, traversal and inferential study was performed from the patients, displaying mild, severe or grave COVID-19, who were received at the HGZ #2 during the period covering a year from January 2021 to January 2022. Once the Bioethics and Research committees granted their approval to continue with the study; a set of patients fulfilling the age, sex, WHO’s advised co-morbidities and disease severity, both qSOFA and qCSI scoring, hospital internment and mortality criteria was covered. From the latter information it was possible to determine that both the qSOFA and qCSI scores are useful to predict a COVID-19 severity development as well as the mortality rate, which was achieved through a differential, inferential and statistical analysis that included ROC curves estimations and regressive binary logistics. A p<0.05 was deemed meaningful. Methods and materials: An analytical, observational, retrospective and traversal study was performed from the patients, displaying mild, severe or grave COVID-19, who were received at the HGZ #2 during the period covering a year from January 2021 to January 2022. Once the Bioethics and Research committees granted their approval to continue with the study; a set of patients fulfilling the age, sex, WHO’s advised co-morbidities and disease severity, both qSOFA and qCSI scoring, hospital internment and mortality criteria was covered. From the latter information it was possible to determine that both the qSOFA and qCSI scores are useful to predict a COVID-19 severity development as well as the mortality rate, which was achieved through a differential, inferential and statistical analysis that included ROC curves estimations and regressive binary logistics. A p<0.05 was deemed meaningful. Results: We included 122 patients (46.7% female and 53.5% male), of whom 42.6% had moderate and 57.4% severe disease. Mortality in patients with COVID-19 included was 50%; in patients with moderate COVID-19 it was 42.3% and in patients with severe COVID-19 55.7%. The mean qCSI score in deceased and survivors was 0.85±0.57 and 0.90±0.54 points, respectively (p=0.626); the mean qSOFA score was 7.6±4.5 points and 6.7±4.6 (p=0.292). The area under the curve (AUC) of the qCSI score was 0.478 (95%CI 0.375-0.581, p=0.673) and for qSOFA it was 0.545 (95%CI 442-0.648, p=0.392). In multivariate analysis qCSI and qSOFA scores were not independent predictors of mortality; only age was significantly associated with a slight increase in mortality (ORa=1.022, 95%CI 1.000-1.044, p=0.05). Conclusions: Neither qSOFA nor qCSI were useful in determining patients; mortality rate at HGZ #2 in the city of Aguascalientes. A better set of scales to predict mortality rate and a more aggressive course of treatment for patients who might need it. Keywords: qCSI, qSOFA, COVID-19, mortality.