Predicting Poor Outcome of COVID-19 Patients on the Day of Admission with the COVID-19 Score

Abstract

Background. COVID-19 may result in multiorgan failure and death. Early detection of patients at risk may allow triage and more intense monitoring. The aim of this study was to develop a simple, objective admission score, based on laboratory tests, that identifies patients who are likely going to deteriorate. Methods. This is a retrospective cohort study of all COVID-19 patients admitted to a tertiary academic medical center in New York City during the COVID-19 crisis in spring 2020. The primary combined endpoint included intubation, stage 3 acute kidney injury (AKI), or death. Laboratory tests available on admission in at least 70% of patients (and age) were included for univariate analysis. Tests that were statistically or clinically significant were then included in a multivariate binary logistic regression model using stepwise exclusion. 70% of all patients were used to train the model, and 30% were used as an internal validation cohort. The aim of this study was to develop and validate a model for COVID-19 severity based on biomarkers. Results. Out of 2545 patients, 833 (32.7%) experienced the primary endpoint. 53 laboratory tests were analyzed, and of these, 47 tests (and age) were significantly different between patients with and without the endpoint. The final multivariate model included age, albumin, creatinine, C-reactive protein, and lactate dehydrogenase. The area under the ROC curve was 0.850 (CI [95%]: 0.813, 0.889), with a sensitivity of 0.800 and specificity of 0.761. The probability of experiencing the primary endpoint can be calculated as p = e − 2.4475 + 0.02492 age − 0.6503 albumin + 0.81926 creat + 0.00388 CRP + 0.00143 LDH / 1 + e − 2.4475 + 0.02492 age − 0.6503 albumin + 0.81926 creat + 0.00388 CRP + 0.00143 LDH . Conclusions. Our study demonstrated that poor outcome in COVID-19 patients can be predicted with good sensitivity and specificity using a few laboratory tests. This is useful for identifying patients at risk during admission.

Admission Predictors of Mortality in Hospitalized COVID-19 Patients—A Serbian Cohort Study

“…Previous studies showed that CKD is a risk factor for ICU admission and unfavorable outcome [ 7 , 8 , 22 ] partially due to persistent low-grade inflammation and dysregulated immune response [ 23 ]. In addition, CKD increases the risk for acute kidney injury and the need for renal-replacement therapy, a known complication of COVID-19 [ 22 , 24 ]. After performing a multivariate logistic regression analysis, the initial 2.652 OR value of e-GFR, as a marker of renal function and CKD stratification, subsided to aOR of 1.852, with borderline statistical significance ( Table 3 ).…”

A Pilot Study on Electrical Impedance Tomography During CPAP Trial in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: The Bright Side of Non-invasive Ventilation

“…Paradigmatic of this struggle is the amendments made by National COVID-19 Clinical Evidence Taskforce (NCCET) (Whang et al, 2021) that deleted the following statement from its revised guidelines "in patients with hypoxemia associated with COVID-19, do not routinely use NIV" (Whang et al, 2021). Since then, a number of studies dealt with the COVID-19 outcome prediction (Tseng et al, 2021), early vs. late intubation (Lee et al, 2021), and criteria for NIV and prediction of NIV failure Bellani et al, 2017;He et al, 2019), so that at present, the debate is still going and no definite recommendations are available, while patients are still largely ventilated with NIV, mainly in non-ICU departments and often by non-ICU trained physicians. An effort to provide clear and simple means to early discriminate patients that require intubation is thus needed, perhaps more due to ethical reasons than purely speculative ones.…”

“…Presently, an increasing amount of studies are reporting successful treatment of SARS-CoV-2 pneumonia in non-intubated patients, ventilated with moderate to high level of positive airways pressure (PEEP/CPAP) (8-12 cmH 2 O) and cycles of awake proning (Bamford et al, 2020;Whang et al, 2021). Accurate selection of patients, appropriate PEEP/CPAP setting, and correct timing for switching to invasive mechanical ventilation in non-responders to the non-invasive approach are thus of paramount importance and still remain among the most debated topics in the intensive care unit (ICU) environment and more (Lee et al, 2021;Tseng et al, 2021).…”

Albumin as a Prognostic Indicator in Pre-Intubated Patients With SARS-CoV-2: A Retrospective, Multi-Institutional Study

“…Topp et al (2021) demonstrated that patients who survived the infection had lower D-dimer, ferritin, lactate dehydrogenase (LDH), and aspartate aminotransferase (AST) levels when they were intubated [2]. Alternatively, a multivariate model aimed at identifying the risk for poor outcomes applied on a sample cohort of 2,545 patients in New York City found that age, albumin, creatinine, C-reactive protein (CRP), and LDH were predictive variables [3]. Identifying at-risk patients is crucial for providing care and determining resource allocation based on patient risk stratification.…”