Development of lab score system for predicting COVID-19 patient severity: A retrospective analysis

Sarkar, Arnab; Sanyal, Surojit; Majumdar, A. S.; Tewari, Devendra Nath; Bhattacharjee, Uttaran; Pal, Juhi

doi:10.1371/journal.pone.0273006

Cited by 4 publications

(3 citation statements)

References 39 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, most COVID-19 severity risk scores require detailed medical history interviews, laboratory tests, and sometimes chest CT scans to assess the severity of pneumonia. As a result, they are not suitable for triage in clinics or emergency rooms with limited medical resources [9][10][11]. The present study aimed to address these challenges.…”

Section: Discussionmentioning

confidence: 99%

Vital Signs as Predictors of Oxygen Requirements in COVID-19 Outpatients: The Development of a Streamlined Risk Score

Iwamura,

Tsutsumi

2024

Cureus

View full text Add to dashboard Cite

Background: With COVID-19 becoming a common disease, primary care facilities such as clinics are required to efficiently triage patients at high risk of severe illness within the constraints of limited medical resources. However, existing COVID-19 severity risk scores require detailed medical history assessments, such as evaluating the severity of pneumonia via chest CT and accounting for past and comorbid conditions. Therefore, they may not be suitable for practical use in clinical settings with limited medical resources, including personnel and equipment.Purpose: The goal is to identify key variables that predict the need for oxygen therapy in COVID-19 patients and develop a simplified clinical risk score based solely on vital signs to predict oxygen requirements.Patients and methods: A retrospective observational study of 584 outpatients with COVID-19 confirmed by polymerase chain reaction test visited Sasebo Chuo Hospital between April 28, 2022, and August 18, 2022. Analyses were conducted after adjustment for background factors of age and sex with propensity score matching. We used the Fisher test for nominal variables and the Kruskal-Wallis test for continuous variables.Results: After adjusting for age and sex, several factors significantly correlated with the need for oxygen within seven days including body temperature (p < 0.001), respiratory rate (p = 0.007), SpO 2 (p < 0.001), and the detection of pneumonia on CT scans (p = 0.032). The area under the receiver-operating characteristic curve for the risk score based on these vital signs and CT was 0.947 (95% confidence interval: 0.911-0.982). The risk score based solely on vital signs was 0.937 (0.900-0.974), demonstrating the ability to predict oxygen administration with no significant differences.Conclusions: Body temperature, advanced age, increased respiratory rate, decreased SpO 2 , and the presence of pneumonia on CT scans were significant predictors of oxygen need within seven days among the study participants. The risk score, based solely on vital signs, effectively and simply assesses the likelihood of requiring oxygen therapy within seven days with high accuracy. The risk score, which utilizes only age and vital signs and does not require a detailed patient history or CT scans, could streamline hospital referral processes for admissions.

show abstract

Section: Discussionmentioning

confidence: 99%

Vital Signs as Predictors of Oxygen Requirements in COVID-19 Outpatients: The Development of a Streamlined Risk Score

Iwamura,

Tsutsumi

2024

Cureus

View full text Add to dashboard Cite

show abstract

“…In addition, this study early measurement (at the time of admission/diagnosis) of mRNA expression of IFNL3 and INFL4 in the nasopharyngeal milieu may act as a non-invasive method to predict the severity of the disease and may complement the more widely used methods in clinical laboratory, such as assessment of coagulation profile (LDH, D-dimers), biochemical and inflammatory markers (creatinine, CRP, ferritin), etc. 43 , 44…”

Section: Discussionmentioning

confidence: 99%

Association of Interferon Lambda 3 and 4 Gene SNPs and Their Expression with COVID-19 Disease Severity: A Cross-Sectional Study

Zahid,

Farooqui,

Zahid

et al. 2023

IDR

View full text Add to dashboard Cite

Introduction Expression and certain SNPs of interferon lambda 3 and 4 (IFNL3 and 4) have been associated with variable outcomes in COVID-19 patients in different regions, suggesting population-specific differences in the disease outcome. This study examined the association of INFL3 and INFL4 SNPs (rs12979860 and rs368234815, respectively) and nasopharyngeal expression with COVID-19 disease severity in Pakistani patients. Methods For this study, 117 retrospectively collected nasopharyngeal swab samples were used from individuals with mild and severe COVID-19 disease. qPCR assays were used to determine the viral loads and mRNA expression of IFNL3 and 4 through the Ct and delta Ct methods, respectively. Due to funding limitations, only one SNP each in INFL3 and INFL4 (found to be most significant through literature search) was analyzed using tetra-arm PCR and RFLP-PCR strategies, respectively. The Mann–Whitney U -test was applied to evaluate the statistical differences in the expression of IFNL3/4 genes in the mild and severe groups, while for SNPs, a Chi-square test was employed. A multivariate Cox regression test was performed to assess the relationship of different variables with COVID-19 severity. Results Comparative analysis of SNPs between mild and severe groups showed only the difference in SNP of the IFNL4 gene to be statistically significant (p = 0.001). Similarly, nasopharyngeal expression of IFNL3 and IFNL4 genes, respectively, was found to be 3.48-fold less and 3.48-fold higher in the severe group as compared to the mild group. Multivariate analysis revealed SNP in the IFNL4 gene and age to have a significant association with COVID-19 severity. Conclusion Despite the small sample size, IFNL4 gene SNP and patient age were associated with COVID-19 severity. Age, IFNL3/IFNL4 mRNA expression in the nasopharyngeal milieu, and the presence of SNP in the IFNL4 (rs368234815) gene in COVID-19 patients may be biomarkers for infection severity and help improve SARS-CoV-2 infection management.

show abstract

“…Although EWS has been used in the evaluation of COVID-19 patients ( Aygun and Eraybar, 2022 ; Fang et al, 2021 ; Huespe et al, 2021 ; Liang et al, 2020 ; Sarkar et al, 2022 ), there are clinical limitations to its use. For instance, the COVID-19 severity index ( Huespe et al, 2021 ) employs vital signs, laboratory parameters, and chest X-ray findings to predict the risk of ICU admission within the next 24 hr.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of COEWS (COVID-19 Early Warning Score) for hospitalized COVID-19 with laboratory features: A multicontinental retrospective study

Klén,

Huespe,

Gregalio

et al. 2023

eLife

View full text Add to dashboard Cite

Background: The emergence of new SARS-CoV-2 variants with significant immune-evasiveness, the relaxation of measures for reducing the number of infections, the waning of immune protection (particularly in high-risk population groups), and the low uptake of new vaccine boosters, forecast new waves of hospitalizations and admission to intensive care units (ICUs). There is an urgent need for easily implementable and clinically effective early warning scores (EWSs) that can predict the risk of complications within the next 24 to 48 hours. Although EWSs have been used in the evaluation of COVID-19 patients, there are several clinical limitations to their use. Moreover, no models have been tested on geographically distinct populations or population groups with varying levels of immune protection.Methods: We developed and validated COEWS, an EWS that is automatically calculated solely from laboratory parameters that are widely available and affordable. We benchmarked COEWS against the widely used NEWS2. We also evaluated the predictive performance of vaccinated and unvaccinated patients.Results: The variables of the COEWS predictive model were selected based on their predictive coefficients and on the wide availability of these laboratory variables. The final model included complete blood count, blood glucose, and oxygen saturation features. To make COEWS more actionable in real clinical situations, we transformed the predictive coefficients of the COEWS model into individual scores for each selected feature. The global score serves as an easy-to-calculate measure indicating the risk of a patient developing the combined outcome of mechanical ventilation or death within the next 48 hours. The discrimination in the external validation cohort was 0.743 (95% confidence interval [CI]: 0.703-0.784) for the COEWS score performed with coefficients and 0.700 (95% CI: 0.654-0.745) for the COEWS performed with scores. The area under the receiver operating characteristic curve (AUROC) was similar in vaccinated and unvaccinated patients. Additionally, we observed that the AUROC of the NEWS2 was 0.677 (95% CI: 0.601-0.752) in vaccinated patients and 0.648 (95% CI: 0.608-0.689) in unvaccinated patients.Conclusions: The COEWS score predicts death or mechanical ventilation within the next 48 hours based on routine and widely available laboratory measurements. The extensive external validation, its high performance, its ease of use, and its positive benchmark in comparison with the widely used NEWS2 position COEWS as a new reference tool for assisting clinical decisions and improving patient care in the upcoming pandemic waves.Funding: University of Vienna.

show abstract

Development of lab score system for predicting COVID-19 patient severity: A retrospective analysis

Cited by 4 publications

References 39 publications

Vital Signs as Predictors of Oxygen Requirements in COVID-19 Outpatients: The Development of a Streamlined Risk Score

Vital Signs as Predictors of Oxygen Requirements in COVID-19 Outpatients: The Development of a Streamlined Risk Score

Association of Interferon Lambda 3 and 4 Gene SNPs and Their Expression with COVID-19 Disease Severity: A Cross-Sectional Study

Development and validation of COEWS (COVID-19 Early Warning Score) for hospitalized COVID-19 with laboratory features: A multicontinental retrospective study

Contact Info

Product

Resources

About