Journal Article

Clinical risk score to predict in-hospital mortality in COVID-19 patients: a retrospective cohort study

Pini, Riccardo, Ungar, Andrea, Mazzeo, Francesca, Fontanari, Paolo, Cesaroni, Giulia, Peris, Adriano, Pieralli, Filippo, Bartoloni, Alessandro, Fumagalli, Stefano, Poggesi, Loredana, Marchionni, Niccolò, Rozzini, Renzo, Fumagalli, Carlo, Vannini, Matteo, Coccia, Flaminia, Cola, Maria, Lavorini, Federico, Marcucci, Rossella, Morettini, Alessandro, Nozzoli, Carlo

2020

Overview

ObjectivesSeveral physiological abnormalities that develop during COVID-19 are associated with increased mortality. In the present study, we aimed to develop a clinical risk score to predict the in-hospital mortality in COVID-19 patients, based on a set of variables available soon after the hospitalisation triage.SettingRetrospective cohort study of 516 patients consecutively admitted for COVID-19 to two Italian tertiary hospitals located in Northern and Central Italy were collected from 22 February 2020 (date of first admission) to 10 April 2020.ParticipantsConsecutive patients≥18 years admitted for COVID-19.Main outcome measuresSimple clinical and laboratory findings readily available after triage were compared by patients’ survival status (‘dead’ vs ‘alive’), with the objective of identifying baseline variables associated with mortality. These were used to build a COVID-19 in-hospital mortality risk score (COVID-19MRS).ResultsMean age was 67±13 years (mean±SD), and 66.9% were male. Using Cox regression analysis, tertiles of increasing age (≥75, upper vs <62 years, lower: HR 7.92; p<0.001) and number of chronic diseases (≥4 vs 0–1: HR 2.09; p=0.007), respiratory rate (HR 1.04 per unit increase; p=0.001), PaO2/FiO2 (HR 0.995 per unit increase; p<0.001), serum creatinine (HR 1.34 per unit increase; p<0.001) and platelet count (HR 0.995 per unit increase; p=0.001) were predictors of mortality. All six predictors were used to build the COVID-19MRS (Area Under the Curve 0.90, 95% CI 0.87 to 0.93), which proved to be highly accurate in stratifying patients at low, intermediate and high risk of in-hospital death (p<0.001).ConclusionsThe COVID-19MRS is a rapid, operator-independent and inexpensive clinical tool that objectively predicts mortality in patients with COVID-19. The score could be helpful from triage to guide earlier assignment of COVID-19 patients to the most appropriate level of care.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: adult intensive & critical care / Aged / Betacoronavirus - isolation & purification / Cohort analysis / Coronavirus Infections - blood / Coronavirus Infections - diagnosis / Coronavirus Infections - mortality / Coronavirus Infections - physiopathology / Coronaviruses / COVID-19 / Critical Care - methods / Critical Care - statistics & numerical data / Critical Pathways - organization & administration / Critical Pathways - standards / Female / Health risks / Hospital Mortality / Hospitalization - statistics & numerical data / Humans / infectious diseases / internal medicine / Italy - epidemiology / Male / Medical Management / Medical prognosis / Middle Aged / Mortality / Pandemics / Pneumonia, Viral - blood / Pneumonia, Viral - diagnosis / Pneumonia, Viral - mortality / Pneumonia, Viral - physiopathology / Prognosis / public health / Respiration, Artificial - statistics & numerical data / Retrospective Studies / Risk Assessment - methods / SARS-CoV-2 / Severe acute respiratory syndrome coronavirus 2 / Triage - methods / Triage - statistics & numerical data