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Vergara Maestre, M.A. Toro Muñoz" "autores" => array:2 [ 0 => array:4 [ "nombre" => "D.A." "apellidos" => "Vergara Maestre" "email" => array:1 [ 0 => "daniel.vergara.m@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.A." "apellidos" => "Toro Muñoz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "ACCIG-SEDARME, Anesthesiology and Critical Care Student Society Colombia-Semillero de anestesiología, reanimación y medicina de urgencia, Facultad de Medicina, Universidad de Caldas, Manizales, Colombia" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un comentario sobre «Proteína C reactiva y escala SOFA: una simple escala como factor predictivo temprano de la necesidad de cuidados críticos en los pacientes con neumonía causada por COVID-19 en España» (Revista Española de Anestesiología y Reanimación 68 (2021) 513−522)" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the article published by Vaquero et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> titled “C-Reactive protein and SOFA scale: A simple score as early predictor of critical care requirement in patients with COVID-19 pneumonia in Spain”, where the authors identify a SOFA score of ≥2 combined with CRP<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>9.1<span class="elsevierStyleHsp" style=""></span>mg/mL on admission as potential predictors of the need for critical care in patients with pneumonia caused by COVID-19. We thank the authors for such valuable evidence; however, we would like to add a few comments.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In some patients, severe COVID-19 respiratory infection may manifest as a rapidly developing acute respiratory distress syndrome with other serious complications that may eventually be followed by multiple organ failure and death. Studies in patients with COVID-19 have shown that a low lymphocyte count, particularly CD8+ cells, and a high leukocyte count together with increased levels of lactate dehydrogenase (LDH), creatine kinase (CK), C-reactive protein (CRP), D-dimer, and high levels of proinflammatory cytokines are associated with more severe inflammation and extensive lung damage, and with higher intensive care unit (ICU) admission and mortality rates.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Smilowitz et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> found that an initial CRP value above the median level (CRP<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>10.8<span class="elsevierStyleHsp" style=""></span>mg/dL) was associated with critical illness (47.6% vs. 25.9%; adjusted odds ratio [aOR] 2.83, 95% CI 2.37–3.37) and in-hospital mortality (32.2% vs 17.8%; ORa 2.59, 95% CI 2.11–3.18) compared to an initial CRP value below the median level (CRP<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>10.8<span class="elsevierStyleHsp" style=""></span>mg/dL). They also correlated CRP values with D-dimer values, and concluded that patients with concomitant elevation of CRP and D-dimer (>384<span class="elsevierStyleHsp" style=""></span>ng/mL) are at greater risk of in-hospital adverse outcomes. Although they also correlate high CRP values with critical illness and mortality, they establish a higher cut-off point than that suggest by Vaquero et al., who do not include D-dimer as a marker of severity. This is important, as other studies have shown the usefulness of D-dimer determination.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Lalueza et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> found the NEWS scale (area under the curve [AUC]): 0.75; 95% CI: 0.69–0.8, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001) to be the most accurate predictor of respiratory failure in patients with COVID-19 at admission, and the difference between this scale and the SOFA scale approached statistical significance (AUC: 0.73; 95% CI: 0.67–0.79; <0.0001). Regarding mortality, the SOFA score (AUC: 0.77; 95% CI: 0.72–0.83; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001) was somewhat more accurate than the other scores, and in this regard the NEWS scale approached statistical significance (AUC: 0.72; 95% CI: 0.66–0.78; <0.0001). This indicates that the NEWS scale is the best predictor of respiratory failure, since it obtained the best AUC in this study, while the SOFA scale is the best instrument for predicting mortality. The foregoing reconfirms the usefulness of sepsis scales in the initial clinical evaluation of patients with COVID-19. It also shows the need for studies evaluating the NEWS scale in conjunction with inflammatory markers, because findings suggest that it may more effective than SOFA at predicting the need for early critical care in patients with pneumonia caused by COVID-19.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In addition, Vaquero et al. excluded patients older than 76 years from the study, when it is precisely these patients that most require critical care due to their increased risk of serious illness and mortality. It would have been important to include this population in the analysis, because the results obtained could have helped develop strategies to improve the poor prognosis of elderly patients with COVID-19.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vergara Maestre DA, Toro Muñoz MA. Un comentario sobre «Proteína C reactiva y escala SOFA: una simple escala como factor predictivo temprano de la necesidad de cuidados críticos en los pacientes con neumonía causada por COVID-19 en España» (Revista Española de Anestesiología y Reanimación 68 (2021) 513−522). Rev Esp Anestesiol Reanim. 2022;69:443–444.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proteína C reactiva y escala SOFA: una simple escala como factor predictivo temprano de la necesidad de cuidados críticos en los pacientes con neumonía causada por COVID-19 en España [C-Reactive protein and SOFA scale: a simple score as early predictor of critical care requirement in patients with COVID-19 pneumonia in Spain]" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.M. Vaquero-Roncero" 1 => "E. Sánchez-Barrado" 2 => "D. Escobar-Macias" 3 => "P. Arribas-Pérez" 4 => "R. González de Castro" 5 => "J.R. González-Porras" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2020.11.014" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2021" "volumen" => "68" "paginaInicial" => "513" "paginaFinal" => "522" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33994585" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Los cambios tempranos en los parámetros de laboratorio son predictores de mortalidad e ingreso en UCI en pacientes con COVID-19: una revisión sistemática y un metanálisis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Kiss" 1 => "N. Gede" 2 => "P. Hegyi" 3 => "D. Németh" 4 => "M. Földi" 5 => "F. Dembrovszky" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00430-020-00696-w" "Revista" => array:6 [ "tituloSerie" => "Med Microbiol Immunol" "fecha" => "2021" "volumen" => "210" "paginaInicial" => "33" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33219397" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "C-reactive protein and clinical outcomes in patients with COVID-19" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.R. Smilowitz" 1 => "D. Kunichoff" 2 => "M. Garshick" 3 => "B. Shah" 4 => "M. Pillinger" 5 => "J.S. Hochman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehaa1103" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2021" "volumen" => "42" "paginaInicial" => "2270" "paginaFinal" => "2279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33448289" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilidad de las escalas de sepsis para predecir el fallo respiratorio y la muerte en pacientes con COVID-19 fuera de las Unidades de Cuidados Intensivos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Lalueza" 1 => "J. Lora-Tamayo" 2 => "C. de la Calle" 3 => "J. Sayas-Catalán" 4 => "E. Arrieta" 5 => "G. Maestro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/J.RCE.2020.10.004" "Revista" => array:2 [ "tituloSerie" => "Rev Clín Esp" "fecha" => "2020" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006900000007/v1_202209110536/S2341192922001202/v1_202209110536/en/main.assets" "Apartado" => array:4 [ "identificador" => "66474" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006900000007/v1_202209110536/S2341192922001202/v1_202209110536/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192922001202?idApp=UINPBA00004N" ]
Journal Information
Vol. 69. Issue 7.
Pages 443-444 (August - September 2022)
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Vol. 69. Issue 7.
Pages 443-444 (August - September 2022)
Letter to the Director
A commentary on “C-Reactive protein and SOFA scale: A simple score as early predictor of critical care requirement in patients with COVID-19 pneumonia in Spain” (Revista Española de Anestesiología y Reanimación 68 (2021) 513−522)
Un comentario sobre «Proteína C reactiva y escala SOFA: una simple escala como factor predictivo temprano de la necesidad de cuidados críticos en los pacientes con neumonía causada por COVID-19 en España» (Revista Española de Anestesiología y Reanimación 68 (2021) 513−522)
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D.A. Vergara Maestre
, M.A. Toro Muñoz
Corresponding author
ACCIG-SEDARME, Anesthesiology and Critical Care Student Society Colombia-Semillero de anestesiología, reanimación y medicina de urgencia, Facultad de Medicina, Universidad de Caldas, Manizales, Colombia
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