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In this context&#44; it seems essential to have validated tools that can determine&#44; as quickly as possible&#44; which SARS-CoV-2-infected patients are at a higher risk of developing respiratory failure and&#47;or dying&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The Sepsis-3 task force recommends the quick Sequential &#40;Sepsis-Related&#41; Organ Failure Assessment &#40;qSOFA&#41; score for identifying patients with suspected infection who are at greater risk of poor outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Subsequent publications found that general early warning scores&#44; such as the National Early Warning Score &#40;NEWS&#41;&#44; were more accurate than the qSOFA score for predicting clinical deterioration&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Some authors propose using a simplified modification of NEWS called quick NEWS &#40;qNEWS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> These scores&#8217; accuracy in predicting a poor clinical outcome have not previously been reported in patients with COVID-19&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This study aimed to evaluate the use of two sepsis-focused criteria&#44; SOFA and qSOFA&#44; and two general early warning scores&#44; qNEWS&#44; and NEWS&#44; calculated at admission for predicting respiratory failure and death among patients with confirmed COVID-19&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Study population and design</span><p id="par0025" class="elsevierStylePara elsevierViewall">This work is a retrospective observational study including all hospitalized adult patients with COVID-19 on March 16&#44; 2020&#46; This day marked the beginning of the worst wave of the epidemic in our region to date&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patient follow-up continued until April 16&#44; 2020 or death&#46; COVID-19 was diagnosed <span class="elsevierStyleItalic">via</span> a SARS-CoV-2 real-time reverse transcription polymerase chain reaction &#40;RT-PCR&#41; of a nasopharyngeal swab or sputum samples&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical characteristics&#44; radiological features&#44; laboratory values&#44; and vital signs at admission were gathered from electronic medical records&#46; For the validation of each case&#44; all the vital signs and laboratory data necessary to calculate qSOFA&#44; SOFA&#44; NEWS&#44; and qNEWS were determined &#40;see Supplementary Table 1&#41;&#46; The first available data from each patient were used to calculate the scores&#46; qNEWS values were calculated using only the blood pressure&#44; respiratory rate&#44; and level of consciousness components of NEWS with the same weightings for each cutoff as in NEWS&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The protocol was approved by the 12 de Octubre Hospital Review Board &#40;reference 20&#47;117&#41; and a waiver of informed consent was granted due to the study&#39;s retrospective observational design&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Definition of endpoints</span><p id="par0045" class="elsevierStylePara elsevierViewall">Respiratory failure was defined as a PaO2&#47;FiO2 ratio &#8804;200<span class="elsevierStyleHsp" style=""></span>mmHg<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> or the need for mechanical ventilation &#40;either non-invasive positive pressure ventilation &#40;including high-flow nasal cannula oxygen&#41; or invasive mechanical ventilation&#41;&#46; Respiratory failure could occur at any time during hospital admission&#46; As Supplementary Table 2 shows&#44; the median time from admission to respiratory failure was 3 days &#40;interquartile ranges&#58; 1&#8211;5&#46;7&#41;&#46; In-hospital mortality during the 30-day follow-up was recorded&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Statistical methods</span><p id="par0050" class="elsevierStylePara elsevierViewall">Descriptive analysis was performed using means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation or medians with interquartile ranges &#40;IQR&#41;&#46; The Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test was used to compare continuous variables with a non-normal distribution and Fisher&#39;s exact test to compare proportions&#46; Predictive accuracy was estimated using sensitivities&#44; specificities&#44; negative and positive predictive values&#44; and negative and positive likelihood ratios&#46; Receiver operating characteristic &#40;ROC&#41; curve analysis was performed to determine the best SOFA&#44; qSOFA&#44; NEWS&#44; and qNEWS cut-off value associated with the presence of respiratory failure or in-hospital death by means of Youden&#39;s index&#46; Statistical analysis was performed with using SPSS Statistics for Windows&#44; Version 19&#46;0 &#40;IBM&#44; Armonk&#44; NY&#58; IBM Corp&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 237 patients were included&#46; Patients&#8217; main demographic and clinical characteristics are shown in Supplementary Table 2&#46; The median time from the onset of symptoms to the first positive RT-PCR was 5 days &#40;interquartile range&#58; 3&#8211;7&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">During hospitalization&#44; 70&#37; of patients needed oxygen therapy while respiratory failure was observed in 32&#37; of cases&#46; ICU admission and overall in-hospital mortality occurred in 12&#46;2&#37; and 20&#46;7&#37; of patients&#44; respectively&#46; Mortality was higher in the respiratory failure group &#40;47&#47;77 &#40;61&#37;&#41; <span class="elsevierStyleItalic">vs&#46;</span> 2&#47;160 &#40;1&#46;3&#37;&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46; ICU mortality was 41&#46;4&#37; &#40;12&#47;29&#41; <span class="elsevierStyleItalic">vs&#46;</span> 17&#46;8&#37; &#40;37&#47;208&#41; in non-ICU patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The most common SOFA&#44; qSOFA&#44; NEWS&#44; and qNEWS values at admission were 0 &#40;35&#37;&#41;&#44; 0 &#40;69&#37;&#41;&#44; 2 &#40;15&#46;6&#37;&#41;&#44; and 0 &#40;57&#46;8&#37;&#41;&#46; Measures of the diagnostic accuracy of SOFA&#44; qSOFA&#44; NEWS&#44; and qNEWS for the presence of respiratory failure or in-hospital death are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The best cut-off values for predicting respiratory failure and mortality for qSOFA&#44; SOFA&#44; NEWS&#44; and qNEWS were &#8805;1&#44; &#8805;2&#44; &#8805;4&#44; and &#8805;2&#44; respectively&#46; These cut-off points were observed in 30&#46;4&#37;&#44; 45&#46;5&#37;&#44; 42&#46;2&#37;&#44; and 22&#46;4&#37; of the study cohort&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">NEWS &#40;AUC&#58; 0&#46;75&#44; 95&#37; CI&#58; 0&#46;69&#8211;0&#46;8&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41; was the most accurate score for predicting respiratory failure at admission &#40;see Supplementary Fig&#46; 1&#41; and the difference with qSOFA approached statistical significance &#40;qSOFA AUC&#58; 0&#46;69&#44; 95&#37; IC&#58; 0&#46;62&#8211;0&#46;74&#44; pairwise comparison&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;09&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding mortality&#44; SOFA &#40;AUC&#58; 0&#46;77&#59; 95&#37; IC&#58; 0&#46;72&#8211;0&#46;83&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41; was slightly more accurate than the other scores &#40;see Supplemenatary Fig&#46; 2 and Table 3&#41;&#46; The specificity and sensitivity of different score cut-offs with 95&#37; confidence intervals are listed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">In a situation like the COVID-19 pandemic&#44; it is vital to predict and identify how many patients are at risk of developing respiratory failure and&#47;or death as soon as possible in order to ensure the appropriate availability of hospital facilities and ventilatory support equipment&#46; Therefore&#44; the use of simple tools such as sepsis scores&#44; which are mainly based on clinical signs&#44; would be of great value for improving the clinical management of this population&#46; However&#44; to date&#44; these scores have not been evaluated in COVID-19 patients&#46; Moreover&#44; these scores have been validated to predict death and ICU transfer&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> but not respiratory failure&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In our experience&#44; up to 30&#37; of hospitalized COVID-19 patients developed respiratory failure&#44; 12&#37; were admitted to the ICU&#44; and 20&#37; died&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The NEWS score seems to be the most suitable tool for predicting respiratory failure as it has the best AUC&#44; better sensitivity and specificity compared to qSOFA&#44; and similar values when compared to the more complex SOFA score&#46; For both outcomes&#44; SOFA has the highest sensitivity whereas qSOFA has the best specificity&#46; Overall&#44; our results on COVID-19 patients are similar to what other authors have reported in non-COVID-19 patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">A striking aspect is that in COVID-19&#44; the NEWS cut-off was &#8805;4&#44; lower than the scores of 5 or 7 which are normally used in sepsis&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;10</span></a> This lower cut-off value could be explained by the fact that patients with COVID-19 do not usually present with hypotension&#8212;in our study&#44; systolic blood pressure &#8804;110<span class="elsevierStyleHsp" style=""></span>mmHg was present in just 15&#37; of patients&#8212;and only 7&#37; had alteration of level of consciousness&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">On the other hand&#44; it should be noted that each score has a high negative predictive value for respiratory failure and mortality&#44; ranging from 79&#8211;84&#37; to 88&#8211;93&#37;&#44; respectively&#46; Therefore&#44; the inclusion of these scores in the early clinical evaluation of patients with COVID-19 might be useful for accurately excluding the development of serious complications&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Overall&#44; our analysis shows that the use of these scores allows for early identification of patients at higher risk&#46; This has direct clinical implications in a pandemic as devastating as COVID-19&#44; making it easier to plan the allocation of scarce and complex resources like ICU beds and respiratory support equipment&#46; This is especially advantageous because the median time from admission to the emergency department to ICU transfer was 1 day &#40;IQR&#58; 1&#8211;5&#41;&#44; which implies that patients may require ICU admission in the first hours of their care&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">An important strength of our study is that patient follow-up lasted for one month or until death&#46; This increases the reliability of our data&#44; since severe COVID-19 patients may have long hospital stays&#46; In fact&#44; the median hospital stays among survivors with respiratory failure and ICU admission were 21 days &#40;IQR 16&#8211;28&#41; and 28 days &#40;IQR 22&#8211;33&#41;&#44; respectively&#46; Median time to in-hospital death was 9 days &#40;IQR 7&#8211;12&#41; &#40;see Supplementary Table 2&#41;&#46; These long hospital stays in patients with severe COVID-19 disease must be taken into account in order to wisely manage hospital resources&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Our analysis has the limitations inherent to retrospective studies&#46; However&#44; vital signs and analytical values were obtained in all cases&#46; Furthermore&#44; this work reports the experience of a single center in the particular context of the first wave of the pandemic&#46; Therefore&#44; our data must be validated by others&#44; especially regarding respiratory failure&#44; given that these scores have previously been used for predicting mortality&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="par0120" class="elsevierStylePara elsevierViewall">In conclusion&#44; the predictive accuracies of sepsis scores in relation to respiratory failure and in-hospital mortality in COVID-19 were similarly useful to those previously reported in sepsis&#46; Overall&#44; we found that early assessment of NEWS is the best tool for predicting respiratory failure in COVID-19 patients and may allow physicians and hospital managers to ensure appropriate management of non-ICU SARS-CoV-2 infected individuals&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Ethical approval</span><p id="par0125" class="elsevierStylePara elsevierViewall">The study protocol was approved by the 12 de Octubre University Hospital Review Board &#40;number reference 20&#47;117&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">Mikel Manche&#241;o-Losa was supported by a &#8220;R&#237;o Hortega&#8221; Research Contract from the Instituto de Salud Carlos III &#40;CM19&#47;00226&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Author contributions</span><p id="par0135" class="elsevierStylePara elsevierViewall">A&#46; Lalueza&#44; J&#46; Lora-Tamayo&#44; C&#46; de la Calle&#44; and C&#46; Lumbreras designed the study&#46; G&#46; Maestro&#44; J&#46; Sayas&#44; R&#46; Garc&#237;a&#44; and A&#46; Lalueza screened the patients&#46; A&#46; Lalueza&#44; J&#46; Lora-Tamayo&#44; C&#46; de la Calle&#44; G&#46; Maestro&#44; J&#46; Sayas&#44; E&#46; Arrieta&#44; M&#46; Manche&#241;o&#44; &#193;&#46; March&#225;n&#44; R&#46; D&#237;az-Sim&#243;n&#44; A&#46; Garc&#237;a-Reyne&#44; and B&#46; de Miguel did data acquisition&#46; A&#46; Lalueza performed the statistical analysis&#46; A&#46; Lalueza and C&#46; Lumbreras created the first draft of the article&#46; A&#46; Lalueza&#44; G&#46; Maestro&#44; M&#46; Catal&#225;n&#44; R&#46; Garc&#237;a&#44; and C&#46; Lumbreras participated in the data interpretation and edited the article&#46; A&#46; Lalueza and C&#46; Lumbreras wrote the final draft of the article and made all the changes suggested by the coauthors&#46;</p></span></span>"
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            1 => "SARS-CoV-2"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This observational retrospective study aimed to investigate the usefulness of Sequential Organ Failure Assessment &#40;SOFA&#41;&#44; Quick SOFA &#40;qSOFA&#41;&#44; National Early Warning Score &#40;NEWS&#41;&#44; and quick NEWS in predicting respiratory failure and death among patients with COVID-19 hospitalized outside of intensive care units &#40;ICU&#41;&#46; We included 237 adults hospitalized with COVID-19 who were followed-up on for one month or until death&#46; Respiratory failure was defined as a PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> ratio &#8804;200<span class="elsevierStyleHsp" style=""></span>mmHg or the need for mechanical ventilation&#46; Respiratory failure occurred in 77 patients &#40;32&#46;5&#37;&#41;&#44; 29 patients &#40;12&#37;&#41; were admitted to the ICU&#44; and 49 patients &#40;20&#46;7&#37;&#41; died&#46; Discrimination of respiratory failure was slightly higher in NEWS&#44; followed by SOFA&#46; Regarding mortality&#44; SOFA was more accurate than the other scores&#46; In conclusion&#44; sepsis scores are useful for predicting respiratory failure and mortality in COVID-19 patients&#46; A NEWS score &#8805;4 was found to be the best cutoff point for predicting respiratory failure&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El presente estudio retrospectivo observacional tiene como objetivo analizar la utilidad de las escalas SOFA &#40;<span class="elsevierStyleItalic">Sequential Organ Failure Assessment</span>&#41;&#44; qSOFA &#40;<span class="elsevierStyleItalic">Quick SOFA</span>&#41;&#44; NEWS &#40;<span class="elsevierStyleItalic">National Early Warning Score&#41;</span> y <span class="elsevierStyleItalic">Quick NEWS</span> para predecir el fallo respiratorio y la muerte en pacientes con COVID-19 atendidos fuera de la Unidad de Cuidados Intensivos &#40;UCI&#41;&#46; Se incluyeron 237 adultos con COVID-19 hospitalizados seguidos durante un mes o hasta su fallecimiento&#46; El fallo respiratorio se defini&#243; como un cociente PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#8804; 200<span class="elsevierStyleHsp" style=""></span>mmHg o la necesidad de ventilaci&#243;n mec&#225;nica&#46; Setenta y siete pacientes &#40;32&#44;5&#37;&#41; desarrollaron fallo ventilatorio&#59; 29 &#40;12&#37;&#41; precisaron ingreso en UCI&#44; y 49 fallecieron &#40;20&#44;7&#37;&#41;&#46; La discriminaci&#243;n del fallo ventilatorio fue algo mayor con la puntuaci&#243;n NEWS&#44; seguida de la SOFA&#46; En cuanto a la mortalidad&#44; la puntuaci&#243;n SOFA fue m&#225;s exacta que las otras escalas&#46; En conclusi&#243;n&#44; las escalas de sepsis son &#250;tiles para predecir el fallo respiratorio y la muerte en COVID-19&#46; Una puntuaci&#243;n &#8805; 4 en la escala NEWS ser&#237;a el mejor punto de corte para predecir fallo respiratorio&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Lalueza A&#44; Lora-Tamayo J&#44; de la Calle C&#44; Sayas-Catal&#225;n J&#44; Arrieta E&#44; Maestro G&#44; et al&#46; 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&#46; Rev Cl&#237;n Esp&#46; 2022&#59;222&#58;293&#8211;298&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">The COVID&#43;12 Group is a member of the SEMI-COVID-19 Network&#44; an initiative of the Spanish Society of Internal Medicine &#40;SEMI&#44; as its initials in Spanish&#41;&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AUC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Youden&#39;s Index&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cut-off&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sensitivity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Specifity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PPV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NVP &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#43;LR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#8722;LR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="10" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Respiratory failure</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>qSOFA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;69 &#40;0&#46;62&#8211;0&#46;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;84 &#40;44&#46;1&#8211;67&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;87 &#40;75&#46;0&#8211;87&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;72 &#40;47&#46;5&#8211;70&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#46;39 &#40;72&#46;2&#8211;85&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;08 &#40;2&#46;1&#8211;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;54 &#40;0&#46;4&#8211;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SOFA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;732 &#40;0&#46;67&#8211;0&#46;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#46;68 &#40;62&#46;3&#8211;83&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;37 &#40;61&#46;6&#8211;76&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;33 &#40;43&#46;4&#8211;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;73 &#40;77&#46;1&#8211;90&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;41 &#40;1&#46;84&#8211;3&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;38 &#40;0&#46;26&#8211;0&#46;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NEWS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;751 &#40;0&#46;69&#8211;0&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;43 &#40;60&#46;0&#8211;81&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;87 &#40;64&#46;2&#8211;78&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;44&#46;7&#8211;64&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;9 &#40;76&#46;4&#8211;89&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;54 &#40;1&#46;91&#8211;3&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4 &#40;0&#46;28&#8211;0&#46;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>qNEWS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;695 &#40;0&#46;63&#8211;0&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;04 &#40;49&#46;2&#8211;72&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;38 &#40;66&#46;8&#8211;80&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;4 &#40;42&#46;5&#8211;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#46;87 &#40;72&#46;3&#8211;85&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;38 &#40;1&#46;73&#8211;3&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;52 &#40;0&#46;4&#8211;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="10" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="10" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In-hospital mortality</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>qSOFA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;716 &#40;0&#46;65&#8211;0&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;27 &#40;48&#46;3&#8211;76&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;19 &#40;71&#46;6&#8211;83&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;31&#46;6&#8211;55&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;1 &#40;83&#8211;93&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;9 &#40;2&#46;06&#8211;4&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;47 &#40;0&#46;32&#8211;0&#46;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SOFA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;778 &#40;0&#46;72&#8211;0&#46;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;48&nbsp;\t\t\t\t\t\t\n
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Journal Information
Vol. 222. Issue 5.
Pages 293-298 (May 2022)
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Vol. 222. Issue 5.
Pages 293-298 (May 2022)
Brief original
The early use of sepsis scores to predict respiratory failure and mortality in non-ICU patients with COVID-19
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
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A. Laluezaa,
Corresponding author
lalueza@hotmail.com

Corresponding author.
, J. Lora-Tamayoa,b,c, C. de la Callea, J. Sayas-Catalánc,d, E. Arrietaa, G. Maestroa, M. Mancheño-Losaa,c, Á. Marchán-Lópeza, R. Díaz-Simóna,b, R. García-Garcíad, M. Cataláne, A. García-Reynea, B. de Miguel-Campoa, C. Lumbrerasa,f, COVID+12 Group
a Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
b Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
c Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, Spain
d Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain
e Unidad de Cuidados Intensivos, Hospital Universitario 12 de Octubre, Madrid, Spain
f Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, Spain
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Tables (2)
Table 1. Measures of diagnostic accuracy for respiratory failure and in-hospital mortality for each score.
Table 2. Sensitivity and specificity for the outcomes across different score cut-offs.
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Additional material (1)
Abstract

This observational retrospective study aimed to investigate the usefulness of Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), National Early Warning Score (NEWS), and quick NEWS in predicting respiratory failure and death among patients with COVID-19 hospitalized outside of intensive care units (ICU). We included 237 adults hospitalized with COVID-19 who were followed-up on for one month or until death. Respiratory failure was defined as a PaO2/FiO2 ratio ≤200mmHg or the need for mechanical ventilation. Respiratory failure occurred in 77 patients (32.5%), 29 patients (12%) were admitted to the ICU, and 49 patients (20.7%) died. Discrimination of respiratory failure was slightly higher in NEWS, followed by SOFA. Regarding mortality, SOFA was more accurate than the other scores. In conclusion, sepsis scores are useful for predicting respiratory failure and mortality in COVID-19 patients. A NEWS score ≥4 was found to be the best cutoff point for predicting respiratory failure.

Keywords:
COVID-19
SARS-CoV-2
Coronavirus
Early warning scores
Sepsis-Related Organ Failure Assessment
Respiratory failure
Resumen

El presente estudio retrospectivo observacional tiene como objetivo analizar la utilidad de las escalas SOFA (Sequential Organ Failure Assessment), qSOFA (Quick SOFA), NEWS (National Early Warning Score) y Quick NEWS para predecir el fallo respiratorio y la muerte en pacientes con COVID-19 atendidos fuera de la Unidad de Cuidados Intensivos (UCI). Se incluyeron 237 adultos con COVID-19 hospitalizados seguidos durante un mes o hasta su fallecimiento. El fallo respiratorio se definió como un cociente PaO2/FiO2 ≤ 200mmHg o la necesidad de ventilación mecánica. Setenta y siete pacientes (32,5%) desarrollaron fallo ventilatorio; 29 (12%) precisaron ingreso en UCI, y 49 fallecieron (20,7%). La discriminación del fallo ventilatorio fue algo mayor con la puntuación NEWS, seguida de la SOFA. En cuanto a la mortalidad, la puntuación SOFA fue más exacta que las otras escalas. En conclusión, las escalas de sepsis son útiles para predecir el fallo respiratorio y la muerte en COVID-19. Una puntuación ≥ 4 en la escala NEWS sería el mejor punto de corte para predecir fallo respiratorio.

Palabras clave:
COVID-19
SARS-CoV-2
Coronavirus
Early Warning Scores
Sepsis-Related Organ Failure Assessment
Fallo respiratorio

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