External Validation and Recalibration of the CURB-65 and PSI for Predicting 30-Day Mortality and Critical Care Intervention in Multiethnic Patients with COVID-19.

OBJECTIVES: To validate and recalibrate the CURB-65 and pneumonia severity index (PSI) in predicting 30-day mortality and critical care intervention (CCI) in a multiethnic population with COVID-19, along with evaluating both models in predicting CCI. METHODS: Retrospective data was collected for 1181 patients admitted to the largest hospital in Qatar with COVID-19 pneumonia. The area under the curve (AUC), calibration curves, and other metrics were bootstrapped to examine the performance of the models. Variables constituting the CURB-65 and PSI scores underwent further analysis using the Least Absolute Shrinkage and Selection Operator (LASSO) along with logistic regression to develop a model predicting CCI. Complex machine learning models were built for comparative analysis. RESULTS: The PSI performed better than CURB-65 in predicting 30-day mortality (AUC 0.83, 0.78 respectively), while CURB-65 outperformed PSI in predicting CCI (AUC 0.78, 0.70 respectively). The modified PSI/CURB-65 model (respiratory rate, oxygen saturation, hematocrit, age, sodium, and glucose) predicting CCI had excellent accuracy (AUC 0.823) and good calibration. CONCLUSIONS: Our study recalibrated, externally validated the PSI and CURB-65 for predicting 30-day mortality and CCI, and developed a model for predicting CCI. Our tool can potentially guide clinicians in Qatar to stratify patients with COVID-19 pneumonia.

The Arabic Version of the Impact of Event Scale-Revised: Psychometric Evaluation among Psychiatric Patients and the General Public within the Context of COVID-19 Outbreak and Quarantine as Collective Traumatic Events.

The Coronavirus Disease-19 (COVID-19) pandemic has provoked the development of negative emotions in almost all societies since it first broke out in late 2019. The Impact of Event Scale-Revised (IES-R) is widely used to capture emotions, thoughts, and behaviors evoked by traumatic events, including COVID-19 as a collective and persistent traumatic event. However, there is less agreement on the structure of the IES-R, signifying a need for further investigation. This study aimed to evaluate the psychometric properties of the Arabic version of the IES-R among individuals in Saudi quarantine settings, psychiatric patients, and the general public during the COVID-19 outbreak. Exploratory factor analysis revealed that the items of the IES-R present five factors with eigenvalues > 1. Examination of several competing models through confirmatory factor analysis resulted in a best fit for a six-factor structure, which comprises avoidance, intrusion, numbing, hyperarousal, sleep problems, and irritability/dysphoria. Multigroup analysis supported the configural, metric, and scalar invariance of this model across groups of gender, age, and marital status. The IES-R significantly correlated with the Depression Anxiety Stress Scale-8, perceived health status, and perceived vulnerability to COVID-19, denoting good criterion validity. HTMT ratios of all the subscales were below 0.85, denoting good discriminant validity. The values of coefficient alpha in the three samples ranged between 0.90 and 0.93. In path analysis, correlated intrusion and hyperarousal had direct positive effects on avoidance, numbing, sleep, and irritability. Numbing and irritability mediated the indirect effects of intrusion and hyperarousal on sleep and avoidance. This result signifies that cognitive activation is the main factor driving the dynamics underlying the behavioral, emotional, and sleep symptoms of collective COVID-19 trauma. The findings support the robust validity of the Arabic IES-R, indicating it as a sound measure that can be applied to a wide range of traumatic experiences.

COVID-19-Related Psychological Trauma and Psychological Distress Among Community-Dwelling Psychiatric Patients: People Struck by Depression and Sleep Disorders Endure the Greatest Burden.

COVID-19 has created a general state of worry and distress, especially among vulnerable groups such as those with psychiatric diagnoses. Worldwide, psychiatric care provision has drastically suffered during the pandemic, with many patients unable to access proper care, which may have implications for increased mental health consequences in patients with psychiatric disorders (e.g., relapse and suicide). This cross-sectional study used structural equation modeling to investigate COVID-19-related trauma and distress among Arab psychiatric population during COVID-19 quarantine. Patients with pre-existing psychiatric disorders (N = 168) completed an online survey that comprised the Depression Anxiety Stress Scale 21 (DASS-21), the Impact of Event Scale-Revised (IES-R), and a questionnaire on COVID-19-related attitudes/perceptions, sources of information, used protective measures, and socio-demographic information. Respondents commonly reported feeling down-hearted/blue, trouble concentrating, along with symptoms of avoidance and rumination related to the pandemic. Patients with depression and sleep disorders expressed higher COVID-19-related trauma than patients with other disorders. Perceived physical health mediated the effect of co-morbid chronic physical disorders on COVID-19 trauma, psychological distress, perceived vulnerability to COVID-19, and perceived likelihood of recovery in case of contracting COVID-19. Perceived physical health and perceived vulnerability to COVID-19 were strong direct predictors of COVID-19-related trauma and psychological distress. Staying at home negatively predicted COVID-19 trauma and exerted an indirect negative effect on psychological distress via COVID-19 trauma. COVID-19 trauma, age, and marital status directly predicted psychological distress, with COVID-19 trauma being the strongest predictor. Educational level, income, having family members working in the medical field, keeping up to date with the news on deaths/infected cases or the development of COVID-19 drugs or vaccines, satisfaction with available information on COVID-19, and using different protective measures were not associated with significant differences in COVID-19 trauma and psychological distress scores. Immuno-psychiatric interventions should be designed to target COVID-19-trauma and distress among younger single patients with perceived poor physical health, especially those diagnosed with depression and sleep disorders.