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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El coronavirus relacionado con el s&#237;ndrome respiratorio agudo grave 2 &#40;SARS-CoV-2&#41; se notific&#243; por primera vez en Wuhan&#44; provincia de Hubei&#44; China<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46; Tras su r&#225;pida propagaci&#243;n mundial&#44; la Organizaci&#243;n Mundial de la Salud declar&#243; la enfermedad por coronavirus 2019 &#40;COVID-19&#41; como pandemia el 11 de marzo de 2020<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a>&#46; La actual pandemia de COVID-19 est&#225; suponiendo retos sin precedentes para los sistemas sanitarios de todo el mundo&#44; especialmente en zonas con una elevada transmisi&#243;n comunitaria&#44; como en Madrid &#40;Espa&#241;a&#41;&#44; donde el n&#250;mero de casos aument&#243; exponencialmente durante las tres primeras semanas de marzo de 2020<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La repentina aparici&#243;n de una infecci&#243;n&#44; cuya principal manifestaci&#243;n cl&#237;nica consiste en una neumon&#237;a grave&#44; supone un enorme reto para garantizar el soporte respiratorio adecuado a todos los pacientes durante la hospitalizaci&#243;n&#46; En este contexto&#44; parece esencial disponer de instrumentos validados que puedan determinar&#44; lo antes posible&#44; qui&#233;nes&#44; de los pacientes infectados por el SARS-CoV-2&#44; tienen un riesgo mayor de sufrir fallo respiratorio y fallecer&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El grupo de trabajo Sepsis-3 recomienda utilizar la puntuaci&#243;n qSOFA &#40;<span class="elsevierStyleItalic">quick Sequential &#91;Sepsis-Related&#93; Organ Failure Assessment</span>&#41; para identificar a los pacientes con sospecha de infecci&#243;n que corren un riesgo mayor de evoluci&#243;n desfavorable<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#46; En publicaciones posteriores se constat&#243; que las puntuaciones generales de alerta temprana&#44; como la escala NEWS &#40;<span class="elsevierStyleItalic">National Early Warning Score</span>&#41;&#44; eran m&#225;s exactas que la puntuaci&#243;n qSOFA para predecir el deterioro cl&#237;nico<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Algunos autores han propuesto el uso de una modificaci&#243;n simplificada de la puntuaci&#243;n NEWS denominada qNEWS &#40;<span class="elsevierStyleItalic">quick NEWS</span>&#41;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#46; A&#250;n no se ha comunicado la exactitud de estas puntuaciones para predecir una evoluci&#243;n cl&#237;nica desfavorable en los pacientes con COVID-19&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de este estudio consisti&#243; en evaluar el uso de dos puntuaciones centradas en la sepsis&#44; SOFA y qSOFA&#44; y dos puntuaciones generales de alerta temprana&#44; qNEWS y NEWS&#44; calculadas en el momento del ingreso para predecir la aparici&#243;n de fallo respiratorio y la mortalidad en pacientes con COVID-19 confirmada&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Materiales y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Poblaci&#243;n y dise&#241;o del estudio</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudio observacional retrospectivo en el que se incluy&#243; a todos los pacientes adultos hospitalizados por COVID-19 el 16 de marzo de 2020&#46; Este d&#237;a se&#241;al&#243; el comienzo de la peor ola de la epidemia en nuestra regi&#243;n hasta la fecha&#46; El seguimiento de los pacientes fue hasta el 16 de abril de 2020 o hasta su muerte&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La COVID-19 se diagnostic&#243; mediante una reacci&#243;n en cadena de la polimerasa con retrotranscripci&#243;n en tiempo real &#40;RT-PCR&#41; positiva para SARS-CoV-2 a partir de un frotis nasofar&#237;ngeo o muestras de esputo&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Las manifestaciones cl&#237;nicas&#44; las caracter&#237;sticas radiol&#243;gicas&#44; los valores anal&#237;ticos y las constantes vitales en el momento del ingreso se obtuvieron a partir de las historias cl&#237;nicas electr&#243;nicas&#46; Para validar cada caso se determinaron todas las constantes vitales y datos anal&#237;ticos necesarios para calcular las puntuaciones qSOFA&#44; SOFA&#44; NEWS y qNEWS &#40;<a class="elsevierStyleCrossRef" href="#sec0060">Tabla 1 suplementaria&#46; Anexo</a>&#41;&#46; Se emplearon los primeros datos disponibles de cada paciente para calcular las puntuaciones&#46; Los valores qNEWS se calcularon utilizando &#250;nicamente los componentes de presi&#243;n arterial&#44; frecuencia respiratoria y grado de conciencia de la puntuaci&#243;n NEWS con las mismas ponderaciones para cada valor de corte que en la NEWS<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El protocolo fue aprobado por el Comit&#233; de &#201;tica de la Investigaci&#243;n con medicamentos del Hospital 12 de Octubre &#40;referencia 20&#47;117&#41; y se concedi&#243; una exenci&#243;n del consentimiento informado debido al dise&#241;o observacional retrospectivo del estudio&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Definici&#243;n de los criterios de valoraci&#243;n</span><p id="par0045" class="elsevierStylePara elsevierViewall">El fallo respiratorio se defini&#243; como un cociente PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#8804;&#160;200 mmHg<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> o la necesidad de ventilaci&#243;n mec&#225;nica &#40;ventilaci&#243;n con presi&#243;n positiva no invasiva &#91;incluido ox&#237;geno por c&#225;nula nasal a alto flujo&#93; o ventilaci&#243;n mec&#225;nica invasiva&#41;&#46; El fallo respiratorio pudo ocurrir en cualquier momento durante el ingreso hospitalario&#46; Seg&#250;n se muestra en la <a class="elsevierStyleCrossRef" href="#sec0060">tabla 2 suplementaria &#40;Anexo&#41;</a>&#44; la mediana del tiempo transcurrido entre el ingreso y la insuficiencia respiratoria fue de tres d&#237;as &#40;rango intercuart&#237;lico&#58;&#160;1-5&#44;7&#41;&#46; Se registr&#243; la mortalidad intrahospitalaria durante el seguimiento de 30 d&#237;as&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">M&#233;todos estad&#237;sticos</span><p id="par0050" class="elsevierStylePara elsevierViewall">El an&#225;lisis descriptivo se realiz&#243; con medias &#177;&#160;desviaci&#243;n est&#225;ndar o medianas con rangos intercuart&#237;licos &#40;RIC&#41;&#46; Se utiliz&#243; la prueba de la U de Mann-Whitney para comparar variables continuas con distribuci&#243;n no normal y la prueba exacta de Fisher para comparar proporciones&#46; La exactitud predictiva se determin&#243; mediante sensibilidades&#44; especificidades&#44; valores predictivos negativos y positivos y cocientes de verosimilitudes negativos y positivos&#46; Se realiz&#243; un an&#225;lisis de &#225;rea bajo la curva &#40;ROC&#41; en curvas de eficacia diagn&#243;stica&#44; para determinar los mejores valores de corte de las puntuaciones SOFA&#44; qSOFA&#44; NEWS y qNEWS asociados a la presencia de insuficiencia respiratoria o mortalidad intrahospitalaria mediante el &#237;ndice de Youden&#46; El an&#225;lisis estad&#237;stico se llev&#243; a cabo con el programa SPSS Statistics para Windows&#44; versi&#243;n 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">Resultados</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se incluyeron un total de 237 pacientes&#46; En la <a class="elsevierStyleCrossRef" href="#sec0060">tabla 2 suplementaria &#40;Anexo&#41;</a> se indican las principales caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas de los pacientes&#46; La mediana del tiempo transcurrido entre el comienzo de los s&#237;ntomas y la primera RT-PCR positiva fue de cinco d&#237;as &#40;rango intercuart&#237;lico&#58;&#160;3-7&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Durante la hospitalizaci&#243;n&#44; el 70&#37; de los pacientes precis&#243; oxigenoterapia&#44; mientras que se observ&#243; fallo respiratorio en el 32&#37; de los casos&#46; La necesidad de ingreso en UCI y la mortalidad intrahospitalaria global fueron&#44; respectivamente&#44; del 12&#44;2 y 20&#44;7&#37;&#46; La mortalidad fue mayor en el grupo con fallo respiratorio &#40;47&#47;77 &#91;61&#37;&#93; frente a 2&#47;160 &#91;1&#44;3&#37;&#93;&#44; p&#160;&#60;&#160;0&#44;0001&#41;&#46; La mortalidad en la UCI fue del 41&#44;4&#37; &#40;12&#47;29&#41; en comparaci&#243;n con el 17&#44;8&#37; &#40;37&#47;208&#41; en los pacientes no ingresados en la UCI &#40;p&#160;&#60;&#160;0&#44;0001&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Los valores m&#225;s frecuentes de las puntuaciones SOFA&#44; qSOFA&#44; NEWS y qNEWS en el momento del ingreso fueron 0 &#40;35&#37;&#41;&#44; 0 &#40;69&#37;&#41;&#44; 2 &#40;15&#44;6&#37;&#41; y 0 &#40;57&#44;8&#37;&#41;&#44; respectivamente&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se presentan las medidas de la exactitud diagn&#243;stica de las puntuaciones SOFA&#44; qSOFA&#44; NEWS y qNEWS en cuanto a la presencia de insuficiencia respiratoria o mortalidad intrahospitalaria&#46; Los mejores valores de corte de las puntuaciones qSOFA&#44; SOFA&#44; NEWS y qNEWS para predecir fallo respiratorio y mortalidad fueron &#8805; 1&#44; &#8805; 2&#44; &#8805; 4 y &#8805; 2&#44; respectivamente&#46; Estos valores de corte se observaron en el 30&#44;4&#44; 45&#44;5&#44; 42&#44;2 y 22&#44;4&#37; de la cohorte del estudio&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">La puntuaci&#243;n NEWS &#40;AUC&#58; 0&#44;75&#59; IC 95&#37;&#58; 0&#44;69-0&#44;8&#44; p&#160;&#60;&#160;0&#44;0001&#41; fue la m&#225;s exacta para predecir fallo respiratorio en el momento del ingreso &#40;<a class="elsevierStyleCrossRef" href="#sec0060">Figura 1 suplementaria&#46; Anexo</a>&#41; y la diferencia con respecto a la qSOFA se aproxim&#243; a la significaci&#243;n estad&#237;stica &#40;AUC de qSOFA&#58; 0&#44;69&#59; IC 95&#37;&#58; 0&#44;62-0&#44;74&#44; comparaci&#243;n emparejada&#59; p&#160;&#61;&#160;0&#44;09&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En cuanto a la mortalidad&#44; la puntuaci&#243;n SOFA &#40;AUC&#58; 0&#44;77&#59; IC 95&#37;&#58; 0&#44;72-0&#44;83&#59; p&#160;&#60;&#160;0&#44;0001&#41; fue algo m&#225;s exacta que las otras puntuaciones &#40;<a class="elsevierStyleCrossRef" href="#sec0060">Figura 2 y Tabla 3 suplementarias&#46; Anexo</a>&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se presentan la especificidad y sensibilidad de diferentes valores de corte de las puntuaciones con IC 95&#37;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discusi&#243;n</span><p id="par0080" class="elsevierStylePara elsevierViewall">En una situaci&#243;n como la pandemia de la COVID-19 resulta esencial predecir e identificar lo antes posible cu&#225;ntos pacientes corren riesgo de sufrir fallo respiratorio o fallecer para garantizar una disponibilidad adecuada de los recursos hospitalarios y equipos de soporte ventilatorio&#46; Por consiguiente&#44; el uso de instrumentos sencillos&#44; como las escalas de sepsis&#44; que se basan principalmente en los signos cl&#237;nicos&#44; ser&#237;an de gran utilidad para mejorar la gesti&#243;n cl&#237;nica de esta poblaci&#243;n&#46; Sin embargo&#44; hasta la fecha&#44; estas puntuaciones no se han evaluado en pacientes con COVID-19&#46; Adem&#225;s&#44; estas puntuaciones se han validado para predecir la mortalidad y el traslado a la UCI<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#44;6</span></a>&#44; pero no el fallo respiratorio&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En nuestra experiencia&#44; hasta el 30&#37; de los pacientes hospitalizados por COVID-19 desarrolla fallo respiratorio&#44; el 12&#37; ingresa en la UCI y el 20&#37; fallece&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La escala NEWS ser&#237;a el instrumento m&#225;s adecuado para predecir el fallo respiratorio porque tiene el mejor AUC&#44; una mayor sensibilidad y especificidad que qSOFA y valores similares a los de la puntuaci&#243;n SOFA&#44; que es m&#225;s compleja&#46; En lo que respecta a ambos criterios de valoraci&#243;n&#44; la puntuaci&#243;n SOFA presenta la m&#225;xima sensibilidad&#44; mientras que qSOFA tiene la mayor especificidad&#46; En general&#44; nuestros resultados en pacientes con COVID-19 son similares a los comunicados por otros autores en pacientes sin COVID-19<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Un aspecto llamativo es que&#44; en la COVID-19&#44; el valor de corte de la puntuaci&#243;n NEWS fue &#8805;&#160;4&#44; menor que las puntuaciones de 5 o 7 que se emplean normalmente en la sepsis<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#44;10</span></a>&#46; Este valor de corte m&#225;s bajo podr&#237;a explicarse por el hecho de que los pacientes con COVID-19 no suelen tener hipotensi&#243;n &#40;en nuestro estudio&#44; tan solo el 15&#37; de los pacientes present&#243; una presi&#243;n arterial sist&#243;lica &#8804;&#160;110&#160;mmHg&#41; y &#250;nicamente el 7&#37; present&#243; una alteraci&#243;n del grado de conciencia&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Por otro lado&#44; hay que se&#241;alar que cada puntuaci&#243;n tiene un alto valor predictivo negativo en cuanto a la presencia de fallo respiratorio y la mortalidad&#44; que oscila entre el 79-84&#37; y el 88-93&#37;&#44; respectivamente&#46; Por consiguiente&#44; la inclusi&#243;n de estas puntuaciones en la evaluaci&#243;n cl&#237;nica inicial de los pacientes con COVID-19 podr&#237;a resultar &#250;til para descartar con exactitud la aparici&#243;n de complicaciones graves&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En general&#44; nuestro an&#225;lisis pone de manifiesto que el uso de estas escalas permite una identificaci&#243;n precoz de los pacientes de mayor riesgo&#46; Esto tiene consecuencias cl&#237;nicas directas en una pandemia tan devastadora como la de COVID-19&#44; de modo que facilita la planificaci&#243;n de la asignaci&#243;n de unos recursos escasos y complejos&#44; como camas de UCI y equipos de soporte respiratorio&#46; Este hecho resulta especialmente &#250;til porque la mediana del tiempo transcurrido entre el ingreso en el servicio de Urgencias y el traslado a la UCI fue de un d&#237;a &#40;RIC&#58;&#160;1-5&#41;&#44; lo que implica que los pacientes pueden requerir ingreso en la UCI en las primeras horas de su atenci&#243;n&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Uno de los puntos fuertes m&#225;s importantes de nuestro estudio es que el seguimiento de los pacientes dur&#243; un mes o hasta su muerte&#46; Ello incrementa la fiabilidad de nuestros datos&#44; ya que los pacientes con COVID-19 grave pueden tener estancias hospitalarias prolongadas&#46; De hecho&#44; la mediana de la estancia hospitalaria en los supervivientes con fallo respiratorio e ingreso en la UCI fue de 21 &#40;RIC&#44; 16-28&#41; y 28 &#40;RIC&#44; 22-33&#41; d&#237;as&#44; respectivamente&#46; La mediana del tiempo transcurrido hasta la muerte intrahospitalaria fue de nueve d&#237;as &#40;RIC&#44; 7-12&#41; &#40;<a class="elsevierStyleCrossRef" href="#sec0060">Tabla 2 suplementaria&#46; Anexo</a>&#41;&#46; Estas estancias hospitalarias prolongadas de pacientes COVID-19 grave deben tenerse en cuenta para gestionar con prudencia los recursos hospitalarios&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Nuestro an&#225;lisis adolece de las limitaciones propias de los estudios retrospectivos&#46; Sin embargo&#44; las constantes vitales y los valores anal&#237;ticos necesarios se obtuvieron en todos los casos&#46; Adem&#225;s&#44; este es un trabajo que comunica la experiencia de un &#250;nico centro en el contexto particular de la primera ola de la pandemia&#46; En consecuencia&#44; estos datos han de ser validados externamente&#44; en particular en lo que respecta al fallo respiratorio&#44; dado que estas escalas se han utilizado antes para predecir la mortalidad&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="par0120" class="elsevierStylePara elsevierViewall">La precisi&#243;n diagn&#243;stica de las escalas de sepsis en relaci&#243;n con el fallo respiratorio y la mortalidad intrahospitalaria en la COVID-19 fueron &#250;tiles&#44; de manera similar a las ya descritas en sepsis&#46; De manera general&#44; se constat&#243; que la determinaci&#243;n precoz de la puntuaci&#243;n NEWS constituye el mejor instrumento para predecir fallo respiratorio en los pacientes con COVID-19 y podr&#237;a permitir a los m&#233;dicos y gerentes de los hospitales garantizar la gesti&#243;n adecuada de los pacientes infectados por el SARS-CoV-2 que no ingresan en la UCI&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Financiaci&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Mikel Manche&#241;o-Losa recibi&#243; financiaci&#243;n mediante un contrato de investigaci&#243;n &#171;R&#237;o Hortega&#187; del Instituto de Salud Carlos III &#40;CM19&#47;00226&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflicto de intereses</span><p id="par0130" class="elsevierStylePara elsevierViewall">Los autores declaran no tener conflicto de intereses&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribuciones de los autores</span><p id="par0150" class="elsevierStylePara elsevierViewall">A&#46; Lalueza&#44; J&#46; Lora-Tamayo&#44; C&#46; de la Calle y C&#46; Lumbreras dise&#241;aron el estudio&#46; G&#46; Maestro&#44; J&#46; Sayas&#44; R&#46; Garc&#237;a y A&#46; Lalueza seleccionaron a los pacientes&#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 y B&#46; de Miguel se encargaron de la obtenci&#243;n de datos&#46; A&#46; Lalueza realiz&#243; el an&#225;lisis estad&#237;stico&#46; A&#46; Lalueza y C&#46; Lumbreras elaboraron el primer borrador del art&#237;culo&#46; A&#46; Lalueza&#44; G&#46; Maestro&#44; M&#46; Catal&#225;n&#44; R&#46; Garc&#237;a y C&#46; Lumbreras participaron en la interpretaci&#243;n de los datos y editaron el art&#237;culo&#46; A&#46; Lalueza y C&#46; Lumbreras redactaron el borrador final del art&#237;culo e hicieron todos los cambios sugeridos por los coautores&#46;</p></span></span>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" 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</span> &#41; 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;&#160;200&#160;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;&#160;4 en la escala NEWS ser&#237;a el mejor punto de corte para predecir fallo respiratorio&#46;</p></span>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" 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;&#160;200&#160;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;&#160;4 was found to be the best cutoff point for predicting respiratory failure&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:3 [
        "etiqueta" => "&#9674;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">El Grupo COVID&#43;12 es miembro de la SEMI-COVID-19 Network&#44; una iniciativa de la Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;&#46;</p>"
        "identificador" => "fn0005"
      ]
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      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0145" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Anexo A"
            "titulo" => "Material adicional"
            "identificador" => "sec0060"
          ]
        ]
      ]
    ]
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      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los datos se presentan en forma de porcentajes con intervalo de confianza &#40;IC&#41; 95&#37;&#46;</p>"
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