A robust COVID-19 mortality prediction calculator based on Lymphocyte count, Urea, C-Reactive Protein, Age and Sex (LUCAS) with chest X-rays

Abstract

There have been numerous risk tools developed to enable triaging of SARS-CoV-2 positive patients with diverse levels of complexity. Here we presented a simplified risk-tool based on minimal parameters and chest X-ray (CXR) image data that predicts the survival of adult SARS-CoV-2 positive patients at hospital admission. We analysed the NCCID database of patient blood variables and CXR images from 19 hospitals across the UK using multivariable logistic regression. The initial dataset was non-randomly split between development and internal validation dataset with 1434 and 310 SARS-CoV-2 positive patients, respectively. External validation of the final model was conducted on 741 Accident and Emergency (A&E) admissions with suspected SARS-CoV-2 infection from a separate NHS Trust. The LUCAS mortality score included five strongest predictors (Lymphocyte count, Urea, C-reactive protein, Age, Sex), which are available at any point of care with rapid turnaround of results. Our simple multivariable logistic model showed high discrimination for fatal outcome with the area under the receiving operating characteristics curve (AUC-ROC) in development cohort 0.765 (95% confidence interval (CI): 0.738–0.790), in internal validation cohort 0.744 (CI: 0.673–0.808), and in external validation cohort 0.752 (CI: 0.713–0.787). The discriminatory power of LUCAS increased slightly when including the CXR image data. LUCAS can be used to obtain valid predictions of mortality in patients within 60 days of SARS-CoV-2 RT-PCR results into low, moderate, high, or very high risk of fatality.

Variant-Related Differences in Laboratory Biomarkers among Patients Affected with Alpha, Delta and Omicron: A Retrospective Whole Viral Genome Sequencing and Hospital-Setting Cohort Study

“…The need for creating a risk tool based on the results of routine blood biomarkers and basic patient information that would ensure the best possible triage for COVID-19 patients led to the development of LUCAS, a COVID-19 mortality prediction calculator [ 33 ]. LUCAS uses patients’ lymphocyte count, urea and C-reactive protein, as well as their age and sex, to categorize them into different risk levels expressed as low, medium, high, and very high risk of death.…”

Modeling mortality risk in patients with severe COVID-19 from Mexico

“…These calculators include multiple demographic, laboratory, and imaging variables with various areas under the curve (AUC) of 0.75 to 0.88. Among these calculators: LUCAS ( 45 ), 4-C Mortality Index ( 46 ), NEWS2 ( 47 ), and COVID-GRAM ( 48 ) have been developed in different populations.…”

Cell‐Based Biomaterials for Coronavirus Disease 2019 Prevention and Therapy

“…[41,129,131,206] Several studies have shown that lymphopenia occurs approximately in 20% of patients with mild and 80% with severe COVID-19. [207,208] It is also a prognostic marker of poor disease outcome. [130] Researchers have found that the direct injection 3.…”

“…[ 41,129,131,206 ] Several studies have shown that lymphopenia occurs approximately in 20% of patients with mild and 80% with severe COVID‐19. [ 207,208 ] It is also a prognostic marker of poor disease outcome. [ 130 ] Researchers have found that the direct injection of NK or T cells is a direct and effective method for alleviation of lymphopenia, which can enhance the immune clearance of SARS‐CoV‐2 in COVID‐19 patients, and relevant clinical trials are underway, as shown in Table 3 .…”