The discovery of four COVID-19 risk groups helps in treatment


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According to data from the world’s largest study patients, people hospitalized with COVID-19 can be divided into four different groups.

Researchers identified groups using clinical information and tests when they arrived at the hospital to predict patients being too high to reduce their risk of death.

A COVID-19 risk detection tool — the most accurate to date — has been designed to be used in a group to help clinical staff choose the best course of treatment for hospitalized patients.

The instrument was created by the ISARIC Coronavirus Clinical Characterization Consortium consisting of researchers from the Universities of Edinburgh, Glasgow, Liverpool and Imperial College London, who used data from some 35,000 patients hospitalized between February and May 2020, in groups of four One of the criteria used to be met.

The tool was then tested and confirmed to be accurate using data from more than 22,000 patients hospitalized from late May to late June 2020.

Some data is used to identify which group a person falls into – and, their risk of dying – this includes age, sex, number of pre-existing conditions, respiratory rate on admission, and results of two blood tests Huh.

One in every hundred patients in the low-risk group were found to be at risk of dying. It was 10 in a hundred patients in the intermediate-risk group, 31 in a hundred in the high-risk group, and 62 in a hundred in the very high-risk group.

New treatments are possible, researchers say.

For example, it may be more appropriate for those who fall into the low-risk subgroup for treatment at home. Conversely, people in high or very high-risk groups may benefit from more aggressive treatment, such as antiviral use and early admission to critical care.

Until now COVID-19 has not been an accurate risk tool for patients. Existing devices of pneumonia or sepsis do not make accurate predictions due to differences between diseases.

Previous attempts to create a risk prediction tool for COVID-19 have had limited success due to the small sample size and lack of formal validation. However, a limitation of this new device is that it can only be used on hospital patients, not within the community.

The work is the latest result of ISARIC — a global network of physicians and scientists who have been preparing for such epidemics to protect disease and death from serious outbreaks since 2012. It included 260 hospitals in England, Wales and Scotland. The ISARIC 4C study included two-thirds of all people hospitalized with COVID-19.

The research was funded by UK Research and Innovation (UKRI) and the Department of Health and Social Care as part of the UK Government’s rapid research response to COVID-19 through the National Institutes of Health Research (NIHR).

Research findings have been published in BMJ.

Senior author and professor of surgery and data science at the University of Edinburgh, Ewen Harrison, said: “As doctors, we want to identify groups of patients at risk of dying from COVID-19. If we can do so from the front. The door to the hospital, then treatment can be better planned. This easing device will help doctors make decisions to provide patients with optimal care. ”

Co-lead author clinical senior lecturer and consultant for infectious diseases at the University of Glasgow, Drs. Antonia Ho said: “This simple device will help doctors at the front door make informed decisions about how to manage patients with COVID-19. On the one hand, targeting early treatment and patients at high risk of dying Allow to enter critical care, and conversely, identify low-risk patients who can be managed safely at home. ”

Professor Callum Semple, chief investigator and professor in outbreak medicine and child health at the University of Liverpool, said: “Our health services are likely to see a lot of pressure this winter, with staff being re-appointed to less familiar acute care areas . In these difficulties. Under the circumstances, 4C is likely to be a valuable tool for mortality support decisions that allow for an accelerated increase in the care of people likely to benefit. Epidemiological public health research measures the success of the ISARIC 4C study Is a testament to the group’s commitment in preparing. ”

Dr. at the University of Edinburgh. Stephen Knight, co-lead author and NIHR Clinical Research Fellow, said: “” This precise and simple risk identification tool, which is applicable across all groups in society, will help in early detection of at-risk individuals when they arrive at the hospital. . Crucially, we will be able to reassure and potentially treat patients at home who fall within the low risk group. ”

Professor Fiona Watt, acting president of the Medical Research Council, part of the UKRI, said: “These results highlight the benefits of getting ready before the emergence of new epidemics such as COVID-19. ISARIC is a global network of physicians and scientists. In 2012 Was quickly established for epidemics such as COVID-19, and its value is evident from the findings described today. ”

Minister for Innovation Lord Betel said, “Protecting the most vulnerable from COVID-19 is a priority, which is why we are supporting such valuable research to help doctors make the best possible decisions for NHS patients Can help, and I am happy to see the former university moving forward. We look forward to seeing how this new tool allows physicians to hospitalize coronovirus patients and potentially save countless lives in the future Can help target treatment more effectively. ”


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more information:
Risk stratification of hospitalized patients with Kovid-19 using ISARIC, BMJ (2020). DOI: 10.1136 / bmj.m3339, www.bmj.com/content/370/bmj.m3339

Provided by the University of Edinburgh

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