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Minerva Medica 2020 Oct 26

DOI: 10.23736/S0026-4806.20.07074-3


language: English

Clinical stability and in-hospital mortality prediction in COVID-19 patients presenting to the Emergency Department

Francesco GAVELLI 1 , Luigi M. CASTELLO 1, Mattia BELLAN 2, Danila AZZOLINA 3, Eyal HAYDEN 2, Michela BELTRAME 1, Alessandra GALBIATI 1, Clara A. GARDINO 1, Maria Luisa GASTALDELLO 1, Francesca GIOLITTI 1, Emanuela LABELLA 1, Filippo PATRUCCO 4, Pier Paolo SAINAGHI 2, Gian Carlo AVANZI 1

1 Emergency Medicine Unit, Department of Translational Medicine, University of Piemonte Orientale, AOU Maggiore della Carità di Novara, Novara, Italy; 2 Internal Medicine and Immunorheumatology Unit, Department of Translational Medicine, University of Eastern Piedmont, AOU Maggiore della Carità, Novara, Italy; 3 Research Support Unit, Department of Translational Medicine at Eastern Piedmont University, Novara, Italy; 4 Department of Translational Medicine, University of Piemonte Orientale, AOU Maggiore della Carità di Novara, Novara, Italy


BACKGROUND: The Novara-COVID score was developed to help the Emergency Physician to decide which Coronavirus disease (COVID) patient required hospitalization at emergency department (ED) presentation and to which intensity of care. We aimed at evaluating its prognostic role.
METHODS: We retrospectively collected data of COVID patients admitted to our ED between March 16th and April 22nd, 2020. The Novara-COVID score was systematically applied to all COVID patients since its introduction in clinical practice and adopted to decide patients’ destination. The ability of the Novara-COVID score to predict in-hospital clinical stability and in-hospital mortality were evaluated through multivariable logistic regression and Cox Regression Hazard models, respectively.
RESULTS: Among the 480 COVID patients admitted to the ED, 338 were hospitalized: the Novara-COVID score was 0-1 in 49.7%, 2 in 24.6%, 3 in 15.4% and 4-5 in 10.3% of patients. Novara-COVID score values of 3 and 4-5 were associated with lower clinical stability with adjusted odds ratios of 0.28 [0.13-0.59] and 0.03 [0.01-0.12], respectively. When in-hospital mortality was evaluated, a significant difference emerged between scores of 0-1 and 2 vs. 3 and 4-5. In particular, the death adjusted Hazard Ratio for Novara-COVID scores of 3 and 4-5 were 2.6 [1.4-4.8] and 8.4 [4.7-15.2], respectively.
CONCLUSIONS: The Novara-COVID score reliably predicts in-hospital clinical instability and mortality of COVID patients at ED presentation. This tool allows the Emergency Physician to detect patients at higher risk of clinical deterioration, suggesting a more aggressive therapeutic management from the beginning.

KEY WORDS: Coronavirus; SARS-CoV-2; Novara-COVID score; Risk stratification; Emergency Medicine

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