Prospective validation of a dynamic prognostic model for identifying COVID-19 patients at high risk of rapid deterioration.
Pharmacoepidemiol Drug Saf
; 32(5): 545-557, 2023 05.
Article
in En
| MEDLINE
| ID: mdl-36464785
ABSTRACT
BACKGROUND:
We sought to develop and prospectively validate a dynamic model that incorporates changes in biomarkers to predict rapid clinical deterioration in patients hospitalized for COVID-19.METHODS:
We established a retrospective cohort of hospitalized patients aged ≥18 years with laboratory-confirmed COVID-19 using electronic health records (EHR) from a large integrated care delivery network in Massachusetts including >40 facilities from March to November 2020. A total of 71 factors, including time-varying vital signs and laboratory findings during hospitalization were screened. We used elastic net regression and tree-based scan statistics for variable selection to predict rapid deterioration, defined as progression by two levels of a published severity scale in the next 24 h. The development cohort included the first 70% of patients identified chronologically in calendar time; the latter 30% served as the validation cohort. A cut-off point was estimated to alert clinicians of high risk of imminent clinical deterioration.RESULTS:
Overall, 3706 patients (2587 in the development and 1119 in the validation cohort) met the eligibility criteria with a median of 6 days of follow-up. Twenty-four variables were selected in the final model, including 16 dynamic changes of laboratory results or vital signs. Area under the ROC curve was 0.81 (95% CI, 0.79-0.82) in the development set and 0.74 (95% CI, 0.71-0.78) in the validation set. The model was well calibrated (slope = 0.84 and intercept = -0.07 on the calibration plot in the validation set). The estimated cut-off point, with a positive predictive value of 83%, was 0.78.CONCLUSIONS:
Our prospectively validated dynamic prognostic model demonstrated temporal generalizability in a rapidly evolving pandemic and can be used to inform day-to-day treatment and resource allocation decisions based on dynamic changes in biophysiological factors.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Clinical Deterioration
/
COVID-19
Type of study:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adolescent
/
Adult
/
Humans
Language:
En
Journal:
Pharmacoepidemiol Drug Saf
Journal subject:
EPIDEMIOLOGIA
/
TERAPIA POR MEDICAMENTOS
Year:
2023
Type:
Article
Affiliation country:
United States