Letter to the Director
Response to the letter to the editor: A comment on C-reactive protein and SOFA scale: a simple scale as an early predictor of the need for critical care in patients with COVID-19 pneumonia in Spain
Réplica a la carta al director: «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»
Luis Mario Vaquero Roncero, Elisa Sánchez Barrado
, Miguel Vicente Sánchez Hernández
Corresponding author
Servicio Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario de Salamanca, Salamanca, Spain
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There are many reasons for this discrepancy, including differences in design and objective. One potential limitation of the aforementioned study<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> is that the authors, for the purpose of calculating sample size before recruitment, did not determine the expected difference in CRP values between the group that required critical care and the one that did not, making it impossible to be certain that the sample size was adequate for the purpose of the study. Smilowitz et al., furthermore, do not use measures to find the best cut-off point (why did they choose 10 mg/dL instead of 9.1 mg/dL, as used in our study?), and the variables used in their multivariate models differ from those used by us in a different population. In addition, the authors do not describe the clinical variables can modify CRP as a marker of the degree of inflammation (time of evolution, previous treatments) nor the distribution among the study groups, making their results unsuitable for comparison with ours. Despite this, Smilowitz et al., like us, found that CRP values are higher in patients that are likely to need critical care.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The same limitations apply to the evaluation of D-dimer data, which, although not the main outcome variable of the study,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> is analysed in subgroups. This methodology limits the potential validity of the results. Furthermore, the authors<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> do not mention whether the patients identified as candidates for critical care on admission to hospital presented higher D-dimer levels than those not requiring this level of care, or whether or not this presumed difference is due to chance, as was the case in our sample.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Regarding the use of the SOFA scale as a predictor of admission to critical care units, the study mentioned by the authors<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> does not evaluate this aspect in particular, although it does indicate that a SOFA score of 2 or more (similar to that found in our study<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>) is as useful as the NEWS scale for predicting respiratory failure. This suggests that our model may also be useful in these patients.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The other review and meta-analysis mentioned<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> do not include an analysis of variables or clinical scales, which probably explains, at least in part, why their results differ from ours.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Nevertheless, despite all these limitations, we observed that the studies cited show that the variables included in the scale used to predict the need for admission to critical care units in patients presenting in the hospital emergency room with pneumonia described in our study are fit for purpose.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have not received funding for this study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vaquero Roncero LM, Sánchez Barrado E, Sánchez Hernández MV. Réplica a la carta al director: «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». Rev Esp Anestesiol Reanim. 2022;69:442–443.</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" "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. 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