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A patient comes to the emergency room, has Covid symptoms and tests positive. Is it possible to predict if you are at risk of getting worse and dying? Yes, according to a study carried out by the University of Florence, the Careggi Hospital and the Poliambulanza Foundation of Brescia, which will be published in the journal BMJ-Open. The authors considered 516 patients with SARS-CoV-2 infection admitted to the two hospitals between February 22 and April 10.
To each his own way of care
The objective of the work was to generate a tool to calculate the probability of death using variables obtainable within two hours after access to the emergency room. This allows healthcare professionals to optimize patient accommodation in low intensity (or even home), intermediate intensity (with non-invasive ventilation systems) or high intensity (resuscitation) areas. One of the aspects that made the effects of the pandemic particularly dramatic was, in fact, the sudden pressure on hospitals for patients in the most varied clinical conditions.
90 percent accurate
The variables considered in the scheme are six: age (the participants were divided into three groups: 18-62 years, 62-74, 75 and older), number of chronic diseases present, respiratory rate (breaths per minute), Rate of Horowitz (which gives indications on pulmonary involvement), creatinine (kidney function), platelet count (to evaluate the possible presence of disseminated intravascular coagulation, one of the most worrisome complications of Covid). The algorithm guarantees very accurate results, with an accuracy level of at least 90%. A new test of its validity is being carried out in patients hospitalized between February and April at the Milan Polyclinic.
Risk variables
Other research groups have proposed criteria to identify the most fragile patients but they are variables that change rapidly, such as troponin (indicating myocardial damage), or that take longer (a measure of pro-inflammatory cytokines) – he says. Niccol Marchionni, tenured professor of Geriatrics at the University of Florence and director of the Cardiothoracovascular Department of the University Hospital of Careggi (as well as author of the Geriatrics forum of Messenger Service) -. Our objective was to set up clinical parameters to be able to stratify the risk level of patients already in the emergency room, quickly and accurately.
The first factor
Among the results of the study, one is particularly relevant: the risk of death (hazard ratio) in patients older than 75 years appears 8 times higher than in those younger than 62, net of adjustment for the other conditions examined, such as the presence of previous pathologies. Therefore, the authors argue, high case fatality affects not only the elderly with chronic diseases, but also those who are relatively healthy. These data may explain, for example, the “massacre” in the RSA and in the municipalities of the Bergamo valleys. It is an absolute priority, the study authors stress, to protect the elderly population with social distancing measures and the systematic use of masks, even in the family environment.
Protect grandparents
The absolute risk of death in those over 75 is extremely significant, Marchionni explains, and may explain why an entire generation has tragically disappeared in the Bergamo area. A reflection helps us to understand the scope of the problem: during aging, even if there are no pathologies, a coronavirus target organ (lungs) and a general metabolic compensation organ (kidneys) show reduced function and the problem simply linked to the advanced age. That is why the infection can be very “bad” in the latter part of life. With the reopening of schools, it will be necessary to pay extreme attention to the elderly: if there is a person over 70-75 years old at home, the ideal would be to use a surgical mask or alternatively that grandparents and parents use an FFP2 throughout the years, when I am in contact with other people. It is also important that people over 65 years of age get vaccinated against the flu: obtaining herd immunity requires coverage of 70-75% in this population group, as recommended by the World Health Organization.
Free tool
The mean age of the 516 patients analyzed was 67 years, and men represented 67% of the total. There were 120 deaths (23.3%, almost one in four): 7 in the low-risk group (4% of the total), 27 in the intermediate (16%) and 86 in the high-risk group (51% ). ). The “COVID-19MRS” risk calculator, capable of distinguishing patients with low, intermediate or high risk of death, a fast clinical tool, free of charge and independent of the subjective judgment of an operator, which allows you to assign patients to the appropriate treatment route from home isolation to intensive care. With an optimization of the healthcare and healthcare resources used.
September 5, 2020 (change September 5, 2020 | 20:31)
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