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BackgroundSince the pandemic outbreak of coronavirus disease 2019 (COVID-19), the health system capacity in highly endemic areas has been overwhelmed. Approaches to efficient management are urgently needed. We aimed to develop and validate a score for early prediction of clinical deterioration of COVID-19 patients. MethodsIn this retrospective multicenter cohort study, we included 1138 mild to moderate COVID-19 patients admitted to 33 hospitals in Guangdong Province from December 27, 2019 to March 4, 2020 (N =818; training cohort), as well as two hospitals in Hubei Province from January 21 to February 22, 2020 (N =320; validation cohort) in the analysis. ResultsThe 14-day cumulative incidences of clinical deterioration were 7.9% and 12.1% in the training and validation cohorts, respectively. An Early WArning Score (EWAS) (ranging from 0 to 4.5), comprising of age, underlying chronic disease, neutrophil to lymphocyte ratio, C-reactive protein, and D-dimer levels, was developed (AUROC: 0.857). By applying the EWAS, patients were categorized into low-, medium-, and high risk groups (cut-off values: two and three). The 14-day cumulative incidence of clinical deterioration in the low-risk group was 1.8%, which was significantly lower than the incidence rates in the medium-(14.4%) and high-risk (40.9%) groups (P <.001). The predictability of EWAS was similar in the validation cohort (AUROC =0.781), patients in the low-, medium-, and high-risk groups had 14-day cumulative incidences of 2.6%, 10.0%, and 25.7%, respectively (P <.001). ConclusionThe EWAS, which is based on five common parameters, can predict COVID-19-related clinical deterioration and may be a useful tool for a rapid triage and establishing a COVID-19 hierarchical management system that will greatly focus clinical management and medical resources to reduce mortality in highly endemic areas.
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Objective To compare and analyze the hemostases effects,contraindication and side effects of procaine and pituitrin in the treatment for pulmonary tuberculosis secondary middle and large haemoptysis of the age.Methods The observation group:to mix procaine(300mg) with glucose(5%) for intravenous drip,15～20gtt/min twice a day.It was maintained 72 hours after the haemoptysis stops.The comparative group:to mix pituitrin(10～20U) with glucose(5%) for intravenous drip,15～20gtt/min twice a day.It was maintained 72 hours after the haemoptysis stops.Results The procaine group had a better hemostatic effect than the pituitrin group;While the pituitrin group had more tangible contraindication and side effects.Conclusion Procaine is more suitable than pituitrin for the treatment for pulmonary haemoptysis of the aged.