Prognosis of COVID-19 pneumonia can be early predicted combining Age-adjusted Charlson Comorbidity Index, CRB score and baseline oxygen saturation

Abstract

In potentially severe diseases in general and COVID-19 in particular, it is vital to early identify those patients who are going to progress to severe disease. A recent living systematic review dedicated to predictive models in COVID-19, critically appraises 145 models, 8 of them focused on prediction of severe disease and 23 on mortality. Unfortunately, in all 145 models, they found a risk of bias significant enough to finally "not recommend any for clinical use". Authors suggest concentrating on avoiding biases in sampling and prioritising the study of already identified predictive factors, rather than the identification of new ones that are often dependent on the database. Our objective is to develop a model to predict which patients with COVID-19 pneumonia are at high risk of developing severe illness or dying, using basic and validated clinical tools. We studied a prospective cohort of consecutive patients admitted in a teaching hospital during the “first wave” of the COVID-19 pandemic. Follow-up to discharge from hospital. Multiple logistic regression selecting variables according to clinical and statistical criteria. 404 consecutive patients were evaluated, 392 (97%) completed follow-up. Mean age was 61 years; 59% were men. The median burden of comorbidity was 2 points in the Age-adjusted Charlson Comorbidity Index, CRB was abnormal in 18% of patients and basal oxygen saturation on admission lower than 90% in 18%. A model composed of Age-adjusted Charlson Comorbidity Index, CRB score and basal oxygen saturation can predict unfavorable evolution or death with an area under the ROC curve of 0.85 (95% CI 0.80–0.89), and 0.90 (95% CI 0.86 to 0.94), respectively. Prognosis of COVID-19 pneumonia can be predicted without laboratory tests using two classic clinical tools and a pocket pulse oximeter.

Molnupiravir Outpatient Treatment for Adults with COVID-19 in a Real-World Setting—A Single Center Experience

“…Pereira et al, in their COVID-19 SOTRs study, observed a relationship between initially lower oxygen saturation and the risk of hospital admission [ 24 ]. Corresponding results were noted in the general population [ 25 , 26 ]. Thus, baseline health condition and oxygenation status have a crucial impact on therapy outcomes and appear to be of paramount importance in predicting the risk of death or hospital admission.…”

Age-adjusted Charlson comorbidity index predicts postoperative mortality in elderly patients with hip fracture: A prospective cohort

“…The aCCI is a significant predictor of survival after cancer ( 19 ), infective endocarditis ( 20 ), transcatheter mitral valve repair ( 21 ), and COVID-19 pneumonia ( 22 ). Presently, there are numerous studies on the association between CCI and mortality in patients with hip fracture, all having reported that high CCI scores were associated with mortality or considered high CCI score to be a risk factor ( 8 , 12 , 23 – 25 ).…”

Radiological Patterns Integration with Duration of Illness in COVID-19 Pneumonia as ‘Evolved’ and ‘Evolving’ Radiological Phenotypes: A Single Center Experience

“…Numerous Authors have observed similar findings in their studies. [47][48][49] Surprisingly, 28.18% of cases in Evolved pneumonia phenotype doesn't require either oxygen or oxygen plus ventilatory support. Rational for this observation would be more consolidations and without or with minimal GGOs or crazy paving and more cases in this category were having less than four-fold inflammatory markers.…”