Derivation of a Clinical Risk Score to Predict 14-Day Occurrence of Hypoxia, ICU Admission, and Death Among Patients with Coronavirus Disease 2019.
J Gen Intern Med
; 36(3): 730-737, 2021 03.
Article
em En
| MEDLINE
| ID: mdl-33274414
ABSTRACT
BACKGROUND:
Uncertainty surrounding COVID-19 regarding rapid progression to acute respiratory distress syndrome and unusual clinical characteristics make discharge from a monitored setting challenging. A clinical risk score to predict 14-day occurrence of hypoxia, ICU admission, and death is unavailable.OBJECTIVE:
Derive and validate a risk score to predict suitability for discharge from a monitored setting among an early cohort of patients with COVID-19.DESIGN:
Model derivation and validation in a retrospective cohort. We built a manual forward stepwise logistic regression model to identify variables associated with suitability for discharge and assigned points to each variable. Event-free patients were included after at least 14 days of follow-up.PARTICIPANTS:
All adult patients with a COVID-19 diagnosis between March 1, 2020, and April 12, 2020, in 10 hospitals in Massachusetts, USA. MAINMEASURES:
Fourteen-day composite predicting hypoxia, ICU admission, and death. We calculated a risk score for each patient as a predictor of suitability for discharge evaluated by area under the curve. KEYRESULTS:
Of 2059 patients with COVID-19, 1326 met inclusion. The 1014-patient training cohort had a mean age of 58 years, was 56% female, and 65% had at least one comorbidity. A total of 255 (25%) patients were suitable for discharge. Variables associated with suitability for discharge were age, oxygen saturation, and albumin level, yielding a risk score between 0 and 55. At a cut point of 30, the score had a sensitivity of 83% and specificity of 82%. The respective c-statistic for the derivation and validation cohorts were 0.8939 (95% CI, 0.8687 to 0.9192) and 0.8685 (95% CI, 0.8095 to 0.9275). The score performed similarly for inpatients and emergency department patients.CONCLUSIONS:
A 3-item risk score for patients with COVID-19 consisting of age, oxygen saturation, and an acute phase reactant (albumin) using point of care data predicts suitability for discharge and may optimize scarce resources.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Respiração Artificial
/
Insuficiência Respiratória
/
Teste para COVID-19
/
COVID-19
/
Unidades de Terapia Intensiva
/
Hipóxia
Tipo de estudo:
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Gen Intern Med
Assunto da revista:
MEDICINA INTERNA
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Estados Unidos