Developing Prediction Models for COVID-19 Outcomes: A Valuable Tool for Resource-Limited Hospitals.

ABSTRACT

Purpose: Coronavirus disease is a global pandemic with millions of confirmed cases and hundreds of thousands of deaths worldwide that continues to create a significant burden on the healthcare systems. The aim of this study was to determine the patient clinical and paraclinical profiles that associate with COVID-19 unfavourable outcome and generate a prediction model that could separate between high-risk and low-risk groups. Patients and Methods: The present study is a multivariate observational retrospective study. A total of 483 patients, residents of the municipality of Timișoara, the biggest city in the Western Region of Romania, were included in the study group that was further divided into 3 sub-groups in accordance with the disease severity form. Results: Increased age (cOR=1.09, 95% CI 1.06-1.11, p<0.001), cardiovascular diseases (cOR=3.37, 95% CI 1.96-6.08, p<0.001), renal disease (cOR=4.26, 95% CI 2.13-8.52, p<0.001), and neurological disorder (cOR=5.46, 95% CI 2.71-11.01, p<0.001) were all independently significantly correlated with an unfavourable outcome in the study group. The severe form increases the risk of an unfavourable outcome 19.59 times (95% CI 11.57-34.10, p<0.001), while older age remains an independent risk factor even when disease severity is included in the statistical model. An unfavourable outcome was positively associated with increased values for the following paraclinical parameters white blood count (WBC; cOR=1.10, 95% CI 1.05-1.15, p<0.001), absolute neutrophil count (ANC; cOR=1.15, 95% CI 1.09-1.21, p<0.001) and C-reactive protein (CRP; cOR=1.007, 95% CI 1.004-1.009, p<0.001). The best prediction model including age, ANC and CRP achieved a receiver operating characteristic (ROC) curve with the area under the curve (AUC) = 0.845 (95% CI 0.813-0.877, p<0.001); cut-off value = 0.12; sensitivity = 72.3%; specificity = 83.9%. Conclusion: This model and risk profiling may contribute to a more precise allocation of limited healthcare resources in a clinical setup and can guide the development of strategies for disease management.