A patient arrives in the emergency room, has Covid symptoms and tests positive. Is it possible to predict if it risks worsening and dying? S, according to a study conducted by the University of Florence, 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.
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To each his own path of care
The aim of the work was to generate a tool for calculating the probability of death using variables obtainable within two hours of accessing 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 the hospitals of patients in the most varied clinical conditions.
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90 percent accuracy
The variables considered in the scheme are six: age (the participants were divided into three groups: 18-62 years, 62-74, from 75 upwards), number of chronic diseases present, respiratory rate (breaths per minute) , Horowitz index (which gives indications on pulmonary compromise), creatinine (renal function), platelet count (to evaluate the possible presence of disseminated intravascular coagulation, one of the most worrying complications of Covid). The algorithm guarantees very accurate results, with an accuracy level of at least 90%. A further test on its validity is underway on patients hospitalized between February and April at the Milan Polyclinic.
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The risk variables
Other research groups have proposed criteria to identify the most fragile patients but they are variables that change quickly, such as troponin (which indicates myocardial damage), or that take longer (measure of proinflammatory cytokines) – he says. Niccol Marchionni, full professor of Geriatrics at the University of Florence and director of the Cardiothoracovascular Department of the Careggi University Hospital (as well as author of Geriatrics forum del Courier service) -. Our goal was to put together clinical parameters to be able to stratify the risk level of patients already at the entrance to the emergency room, quickly and with precision.
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The first factor
Among the results of the study, one is particularly relevant: the risk of death (hazard ratio) in patients over 75 years old it appears 8 times higher than in under 62, net of the adjustment for the other conditions examined, such as the presence of previous pathologies. Thus, the authors argue, high lethality affects not only the elderly with chronic diseases, but also those who are relatively healthy. This data can explain, for example, the “massacre” in the RSA and in the municipalities of the Bergamo valleys. absolutely priority, underline the authors of the study, to protect the elderly population with measures of social distancing and the systematic use of masks, even in the family.
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Protect grandparents
The absolute risk of death in over 75s is extremely significant – Marchionni explains – and can explain why an entire generation has tragically disappeared in the Bergamo area. A reflection helps us to understand the extent of the problem: during aging, even if there are no pathologies, a target organ of the coronavirus (lungs) and a general metabolic compensation organ (kidneys) show reduced function and the problem just linked to advancing age. This is why infection can be much “bad” in the latter part of life. With the reopening of the schools it will be necessary to pay extreme attention to the elderly: if an over 70-75 person is present at home, the ideal would be to wear a surgical mask or alternatively to have grandparents and parents wear a FFP2 over the years, when I am in contact with other people. It is also important that people over 65 get vaccinated against the flu: to obtain herd immunity, coverage of 70-75% in this population group is required, as recommended by the World Health Organization.
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No cost tool
The average age of the 516 patients analyzed was 67 years and males 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 group), 27 in the intermediate (16%) and 86 in the high-risk group (51%). ). The “COVID-19MRS” risk calculator, able to distinguish patients at low, intermediate or high risk of death, a rapid clinical tool, at no cost and independent of the subjective judgment of an operator, which allows you to assign patients to the appropriate treatment path, from home isolation to intensive care. With an optimization of assistance and health resources used.
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September 5, 2020 (change September 5, 2020 | 20:31)
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