Development and external validation of the DOAT and DOATS scores: simple decision support tools to identify disease progression among nonelderly patients with mild/moderate COVID-19.

BACKGROUND: During the fifth wave of the coronavirus disease 2019 (COVID-19) pandemic in Japan, which took place between June and September 2021, a significant number of COVID-19 cases with deterioration occurred in unvaccinated individuals < 65 years old. However, the risk factors for COVID-19 deterioration in this specific population have not yet been determined. This study developed a prediction method to identify COVID-19 patients < 65 years old who are at a high risk of deterioration. METHODS: This retrospective study analyzed data from 1,675 patients < 65 years old who were admitted to acute care institutions in Fukushima with mild-to-moderate-1 COVID-19 based on the Japanese disease severity criteria prior to the fifth wave. For validation, 324 similar patients were enrolled from 3 hospitals in Yamagata. Logistic regression analyses using cluster-robust variance estimation were used to determine predictors of disease deterioration, followed by creation of risk prediction scores. Disease deterioration was defined as the initiation of medication for COVID-19, oxygen inhalation, or mechanical ventilation starting one day or later after admission. RESULTS: The patients whose condition deteriorated (8.6%) tended to be older, male, have histories of smoking, and have high body temperatures, low oxygen saturation values, and comorbidities, such as diabetes/obesity and hypertension. Stepwise variable selection using logistic regression to predict COVID-19 deterioration retained comorbidities of diabetes/obesity (DO), age (A), body temperature (T), and oxygen saturation (S). Two predictive scores were created based on the optimism-corrected regression coefficients: the DOATS score, including all of the above risk factors, and the DOAT score, which was the DOATS score without oxygen saturation. In the original cohort, the areas under the receiver operating characteristic curve (AUROCs) of the DOATS and DOAT scores were 0.81 (95% confidence interval [CI] 0.77-0.85) and 0.80 (95% CI 0.76-0.84), respectively. In the validation cohort, the AUROCs for each score were both 0.76 (95% CI 0.69-0.83), and the calibration slopes were both 0.80. A decision curve analysis confirmed the clinical practicability of both scores in the validation cohort. CONCLUSIONS: We established two prediction scores that can quickly evaluate the risk of COVID-19 deterioration in mild/moderate patients < 65 years old.

A case of pulmonary tuberculosis with hemoptysis from a peripheral pulmonary aneurysm.

An 88-year-old woman visited our hospital for hemoptysis due to ruptured peripheral pulmonary aneurysm diagnosed by contrast computed tomography (CT) and angiography. Her bleeding was stopped by interventional radiology vascular embolization. She was diagnosed with pulmonary tuberculosis due to a positive acid-fast bacillus (AFB) smear test following admission and the positive polymerase chain reaction for tuberculosis, despite no obvious cavity lesions or scatter shadows on CT. The causes of hemoptysis due to pulmonary tuberculosis are known to be Rasmussen aneurysm, in which the blood vessel wall adjacent to the lung cavity is thinned to form an aneurysm, or bleeding from the bronchial artery. In this case, it was considered that the inflammation caused by pulmonary tuberculosis spread directly to the pulmonary artery and formed a pulmonary aneurysm without forming a cavity. Similar cases have been rarely reported. Clinicians need to consider pulmonary tuberculosis as the cause of pulmonary aneurysm, even without cavity lesions in the lungs. It is important to perform AFB examination to diagnose pulmonary tuberculosis.