Exploratory COVID-19 death risk score based on basic laboratory tests and physiological clinical measurements

doi:10.5847/wjem.j.1920-8642.2022.103

Abstract

Abstract:

BACKGROUND: In the event of a sudden shortage of medical resources, a rapid, simple, and accurate prediction model is essential for the 30-day mortality rate of patients with COVID-19.

METHODS: This retrospective study compared the characteristics of the survivals and non-survivals of 278 patients with COVID-19. Logistic regression analysis was performed to obtain the “COVID-19 death risk score” (CDRS) model. Using the area under the receiver operating characteristic (AUROC) curve and Hosmer-Lemeshow goodness-of-fit test, discrimination and calibration were assessed. Internal validation was conducted using a regular bootstrap method.

RESULTS: A total of 63 (22.66%) of 278 included patients died. The logistic regression analysis revealed that high-sensitivity C-reactive protein (hsCRP; odds ratio [OR]=1.018), D-dimer (OR=1.101), and respiratory rate (RR; OR=1.185) were independently associated with 30-day mortality. CDRS was calculated as follows: CDRS=-10.245+(0.022×hsCRP)+(0.172×D-dimer)+(0.203×RR). CDRS had the same predictive effect as the sequential organ failure assessment (SOFA) and “confusion, uremia, respiratory rate, blood pressure, and age over 65 years” (CURB-65) scores, with AUROCs of 0.984 for CDRS, 0.975 for SOFA, and 0.971 for CURB-65, respectively. And CDRS showed good calibration. The AUROC through internal validations was 0.980 (95% confidence interval [CI]: 0.965-0.995). Regarding the clinical value, the decision curve analysis of CDRS showed a net value similar to that of CURB-65 in this cohort.

CONCLUSION: CDRS is a novel, efficient and accurate prediction model for the early identification of COVID-19 patients with poor outcomes. Although it is not as advanced as the other models, CDRS had a similar performance to that of SOFA and CURB-65.

Key words: COVID-19, 30-day mortality, Prediction model

Gui-ying Dong, Fei-fei Jin, Qi Huang, Chun-bo Wu, Ji-hong Zhu, Tian-bing Wang. Exploratory COVID-19 death risk score based on basic laboratory tests and physiological clinical measurements[J]. World Journal of Emergency Medicine, 2022, 13(6): 453-458.

Figures/Tables 6

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Variables	All (n=278)	Survival (n=215)	Non-survival (n=63)	P-value
Demographics
Male	146 (52.52)	107 (49.77)	39 (61.90)	0.090
Age, years	64 (52-71)	61 (49-69)	70 (62-80)	<0.001*
Youth (18-65 years)	156 (56.12)	136 (63.26)	20 (31.75)	<0.001*
Middle-aged (66-79 years)	92 (33.09)	66 (30.70)	26 (41.27)	0.185
Elderly (80-99 years)	30 (10.79)	13 (6.05)	17 (26.98)	<0.001*
Comorbidity
Hypertension	113 (40.65)	86 (40.00)	27 (42.86)	0.685
Diabetes mellitus	57 (20.50)	39 (18.14)	18 (28.57)	0.071
Cardiovascular disease	53 (19.06)	34 (15.81)	19 (30.16)	0.011*
Chronic pulmonary disease	25 (8.99)	14 (6.51)	11 (17.46)	0.008*
Chronic kidney disease	16 (5.76)	15 (6.98)	1 (1.59)	0.102
Malignancy tumor	10 (3.60)	6 (2.79)	4 (6.35)	0.182
Chronic liver disease	7 (2.52)	4 (1.86)	5 (7.94)	0.017*
Intervention during hospital
Mechanical ventilation	71 (25.54)	11 (5.11)	60 (95.24)	<0.001*
Vasoactive drug therapy	42 (15.11)	4 (1.86)	42 (66.67)	<0.001*

Risk factors	Univariate regression analysis		Multivariate regression analysis
Risk factors	OR (95%CI)	P-value	OR (95%CI)	P-value
Age	1.066 (1.040-1.094)	<0.001*	1.080 (0.979-1.193)	0.126
RR	1.292 (1.212-1.376)	<0.001*	1.185 (1.032-1.361 )	0.016*
WBC	1.505 (1.351-1.678)	<0.001*	1.131 (0.943-1.358)	0.185
D-dimer	1.264 (1.199-1.334)	<0.001*	1.101 (0.986-1.229)	0.089*
hsCRP	1.026 (1.020-1.033)	<0.001*	1.018 (1.003-1.033)	0.017*
IL-6	1.024 (1.017-1.031)	<0.001*	1.003 (0.992-1.014)	0.628
Ferritin	1.001 (1.001-1.002)	<0.001*	1.001 (1.000-1.002)	0.207
hsTnI	1.002 (1.001-1.003)	0.001*	1.000 (1.000-1.000)	0.606
NT-proBNP	1.000 (1.000-1.000)	<0.001*	1.000 (1.000-1.000)	0.272
Scr	1.003 (1.002-1.005)	<0.001*	1.002 (0.999-1.006)	0.192
ALT	1.013 (1.006-1.019)	<0.001*	1.015 (0.987-1.042)	0.298

Scores	All (n=278)	Survival (n=215)	Non-survival (n=63)	P-value	AUC (95% CI)	Cut-off
CDRS	-2.80 (-5.72 - -1.01)	-4.71 (-6.05 - -3.96)	3.71 (1.12-6.54)	<0.001*	0.984 (0.969-0.998)	-1.14
SOFA	2 (0-4)	1 (0-2)	12 (8-15)	<0.001*	0.975 (0.945-1.000)	5
CURB-65	1 (0-2)	1 (0-1)	4 (3-5)	<0.001*	0.971 (0.949-0.994)	3