COVID-19 Outpatient Screening: a Prediction Score for Adverse Events

Sun, Haoqi; Jain, Aayushee; Leone, Michael J.; Alabsi, Haitham; Brenner, Laura; Ye, Elissa; Ge, Wendong; Shao, Yu-Ping; Boutros, Christine L.; Wang, Ruopeng; Tesh, Ryan A.; Magdamo, Colin; Collens, Sarah I.; Ganglberger, Wolfgang; Bassett, Ingrid V.; Meigs, James B.; Kalpathy–Cramer, Jayashree; Li, Matthew; Chu, Jacqueline T.; Dougan, Michael; Stratton, Lawrence W.; Rosand, Jonathan; Fischl, Bruce; Das, Sudeshna; Mukerji, Shibani S.; Robbins, Gregory K.; Westover, M. Brandon

doi:10.1101/2020.06.17.20134262

Cited by 10 publications

(15 citation statements)

References 16 publications

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“…Data concerning admission BP in patients with COVID-19 are very scarce and are included, at best, as minor pieces of data in larger predictive scores. Two recent studies found an association between worse outcomes and low BP 16 , 17 and 2 others found an association between worse outcomes and high BP. 18 , 19 However, none focused on the capital importance of BP per se.…”

Section: Discussionmentioning

confidence: 96%

Impact of Arterial Stiffness on All-Cause Mortality in Patients Hospitalized With COVID-19 in Spain

et al. 2021

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Older age and cardiovascular comorbidities are well-known risk factors for all-cause mortality in COVID-19 patients. Hypertension (HT) and age are the two principal determinants of arterial stiffness (AS). This study aimed to estimate AS in COVID-19 patients requiring hospitalization and analyze its association with all-cause in-hospital mortality. This observational, retrospective, multicenter cohort-study analyzed 12,170 patients admitted to 150 Spanish centers included in the SEMI-COVID-19 Network. We compared AS, defined as pulse pressure {greater than or equal to} 60 mmHg, and clinical characteristics between survivors and nonsurvivors. Mean age was 67.5 {plus minus} 16.1 years and 42.5% were women. Overall, 2,606 (21.4%) subjects died. Admission systolic blood pressure (SBP) < 120 and {greater than or equal to} 140 mmHg was a predictor of higher all-cause mortality (23.5% and 22.8%, respectively, p < .001), compared to BP =120-140 mmHg (18.6%). The 4,379 patients with AS (36.0%) were older and had higher systolic and lower diastolic BP. Multivariate analysis showed that AS and SBP < 120 mmHg significantly and independently predicted all-cause in-hospital mortality (ORadj: 1.27, p=.0001; ORadj: 1.48, p=.0001, respectively) after adjusting for sex (males, ORadj: 1.6, p=.0001), age tertiles (second and third tertiles, ORadj: 2.0 and 4.7, p=.0001), Charlson Comorbidity Index (second and third tertiles, ORadj: 4.8 and 8.6, p=.0001), heart failure, and previous and in-hospital antihypertensive treatment. Our data show that AS and admission SBP < 120 mmHg had independent prognostic value for all-cause mortality in COVID-19 patients requiring hospitalization.

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Section: Discussionmentioning

confidence: 96%

Impact of Arterial Stiffness on All-Cause Mortality in Patients Hospitalized With COVID-19 in Spain

et al. 2021

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“…We found no major difference in the diagnostic yield between resting and ambulatory SaO 2 in this setting. The predictive value of outpatient oxygen saturation values have been previously described (5, 22). One study provided pulse oximeters to participants with COVID-19 who presented to an ED or outpatient testing centers; 29% required subsequent hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, no single oxygen saturation reading alone predicted outcome as there was overlap in both the resting and ambulatory oxygen saturations of those who remained at home and those who were hospitalized. Therefore, pulse oximetry may be most useful as an adjunct to clinical monitoring of high risk populations such as those over 60 years of age, males, and persons with elevated body mass index (5, 23).…”

Section: Discussionmentioning

confidence: 99%

The clinical course of COVID-19 in the outpatient setting: a prospective cohort study

Blair

Brown

Jang

et al. 2020

Preprint

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Background: Outpatient COVID-19 has been insufficiently characterized. Objective: To determine the progression of disease and subsequent determinants of hospitalization. Design: A prospective outpatient cohort. Setting: Outpatients were recruited by phone between April 21 to June 23, 2020 after receiving outpatient or emergency department testing within a large health network in Maryland, USA. Participants: Outpatient adults with positive RT-PCR results for SARS-CoV-2. Measurements: Symptoms, portable pulse oximeter oxygen saturation (SaO2), heart rate, and temperature were collected by participants on days 0, 3, 7, 14, 21, and 28 after enrollment. Baseline demographics, comorbid conditions were evaluated for risk of subsequent hospitalization using negative binomial, logistic, and random effects logistic regression. Results: Among 118 SARS-CoV-2 infected outpatients, the median age was 56.0 years (IQR, 50.0 to 63.0) and 50 (42.4%) were male. Among those reporting active symptoms, the most common symptoms during the first week since symptom onset included weakness/fatigue (67.3%), cough (58.0%), headache (43.8%), and sore throat (34.8%). Participants returned to their usual health a median of 20 days (IQR, 13 to 38) from the symptom onset, and only 65.5% of respondents were at their usual health during the fourth week of illness. Over 28 days, 10.9% presented to the emergency department and 7.6% required hospitalization. Individuals at the same duration of illness had a 6.1 times increased adjusted odds of subsequent hospitalization per every percent decrease in home SaO2 (95% confidence interval [CI]: 1.41 to 31.23, p=0.02). Limitations: Severity and duration of illness may differ in a younger population. Conclusion: Symptoms often persisted but uncommonly progressed to hospitalization. Home SaO2 might be an important adjunctive tool to identify progression of COVID-19.

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“…A second tool, from the United States, was found to be less sensitive and specific, despite including a greater number of resourceintensive inputs. 21 In the Jiangsu Province of China, Sun et al 22 validated a homegrown system for triaging confirmed COVID-19 patients. The algorithm includes seven inputs: age, blood oxygen saturation, CT scan results, heart rate, lymphocyte count, oxygenation requirements, and respiratory rate.…”

Section: Questionsmentioning

confidence: 99%

“…A total of 25 studies were identified that described triage protocols for COVID-19 patients, 11 of which were from LMICs. There were only two 21 validation studies related to these tools, one of which was from China, 22 an upper-middle–income country. There were 48 severity scoring tools described in the literature, 23 of which were from LMICs.…”

Section: Questionsmentioning

confidence: 99%

Pragmatic Recommendations for Identification and Triage of Patients with COVID-19 Disease in Low- and Middle-Income Countries

Barros

Pigoga

Chea

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Effective identification and prognostication of severe COVID-19 patients presenting to healthcare facilities are essential to reducing morbidity and mortality. Low- and middle-income country (LMIC) facilities often suffer from restrictions in availability of human resources, laboratory testing, medications, and imaging during routine functioning, and such shortages may worsen during times of surge. Low- and middle-income country healthcare providers will need contextually appropriate tools to identify and triage potential COVID-19 patients. We report on a series of LMIC-appropriate recommendations and suggestions for screening and triage of COVID-19 patients in LMICs, based on a pragmatic, experience-based appraisal of existing literature. We recommend that all patients be screened upon first contact with the healthcare system using a locally approved questionnaire to identify individuals who have suspected or confirmed COVID-19. We suggest that primary screening tools used to identify individuals who have suspected or confirmed COVID-19 include a broad range of signs and symptoms based on standard case definitions of COVID-19 disease. We recommend that screening include endemic febrile illness per routine protocols upon presentation to a healthcare facility. We recommend that, following screening and implementation of appropriate universal source control measures, suspected COVID-19 patients be triaged with a triage tool appropriate for the setting. We recommend a standardized severity score based on the WHO COVID-19 disease definitions be assigned to all suspected and confirmed COVID-19 patients before their disposition from the emergency unit. We suggest against using diagnostic imaging to improve triage of reverse transcriptase (RT)-PCR–confirmed COVID-19 patients, unless a patient has worsening respiratory status. We suggest against the use of point-of-care lung ultrasound to improve triage of RT-PCR–confirmed COVID-19 patients. We suggest the use of diagnostic imaging to improve sensitivity of appropriate triage in suspected COVID-19 patients who are RT-PCR negative but have moderate to severe symptoms and are suspected of a false-negative RT-PCR with high risk of disease progression. We suggest the use of diagnostic imaging to improve sensitivity of appropriate triage in suspected COVID-19 patients with moderate or severe clinical features who are without access to RT-PCR testing for SARS-CoV-2.

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COVID-19 Outpatient Screening: a Prediction Score for Adverse Events

Cited by 10 publications

References 16 publications

Impact of Arterial Stiffness on All-Cause Mortality in Patients Hospitalized With COVID-19 in Spain

Impact of Arterial Stiffness on All-Cause Mortality in Patients Hospitalized With COVID-19 in Spain

The clinical course of COVID-19 in the outpatient setting: a prospective cohort study

Pragmatic Recommendations for Identification and Triage of Patients with COVID-19 Disease in Low- and Middle-Income Countries

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