Development and Validation of a Web-Based Severe COVID-19 Risk Prediction Model

Abstract

Background: Coronavirus disease 2019 (COVID-19) carries high morbidity and mortality globally. Identification of patients at risk for clinical deterioration upon presentation would aid in triaging, prognostication, and allocation of resources and experimental treatments. Research Question: Can we develop and validate a web-based risk prediction model for identification of patients who may develop severe COVID-19, defined as intensive care unit (ICU) admission, mechanical ventilation, and/or death? Methods: This retrospective cohort study reviewed 415 patients admitted to a large urban academic medical center and community hospitals. Covariates included demographic, clinical, and laboratory data. The independent association of predictors with severe COVID-19 was determined using multivariable logistic regression. A derivation cohort (n=311, 75%) was used to develop the prediction models. The models were tested by a validation cohort (n=104, 25%). Results: The median age was 66 years (Interquartile range [IQR] 54-77) and the majority were male (55%) and non-White (65.8%). The 14-day severe COVID-19 rate was 39.3%; 31.7% required ICU, 24.6% mechanical ventilation, and 21.2% died. Machine learning algorithms and clinical judgment were used to improve model performance and clinical utility, resulting in the selection of eight predictors: age, sex, dyspnea, diabetes mellitus, troponin, C-reactive protein, D-dimer, and aspartate aminotransferase. The discriminative ability was excellent for both the severe COVID-19 (training area under the curve [AUC]=0.82, validation AUC=0.82) and mortality (training AUC= 0.85, validation AUC=0.81) models. These models were incorporated into a mobile-friendly website. Interpretation: This web-based risk prediction model can be used at the bedside for prediction of severe COVID-19 using data mostly available at the time of presentation.

An internally validated prediction model for critical COVID-19 infection and intensive care unit admission in symptomatic pregnant women

“…Our findings regarding the serum markers of inflammation and blood count parameters such as neutrophil/ lymphocyte ratio are consistent with the published literature. 16,17 The mini-COMIT model incorporating only maternal and pregnancy characteristics had a lower predictive accuracy than the results of Tutiya et al 18 (AUROC: 0.73 vs 0.82). However, we obtained optimismadjusted area under the curve (AUC) values, aimed for the most parsimonious model within the constraints of an adverse outcome group size and employed a much larger cohort.…”

“…Several prediction models have been proposed for use in nonpregnant adults with COVID-19 with varying success. 4,6,16,17 Most models utilized laboratory parameters at the time of diagnosis, whereas some also incorporated imaging studies. A systematic review of the published models criticized the optimistic prediction estimates and poor reporting.…”