Corpus overview


Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Prognostic value of sTREM-1 in COVID-19 patients: a biomarker for disease severity and mortality

    Authors: Pedro V da Silva Neto; Jonatan C S de Carvalho; Vinicius E Pimentel; Malena M Perez; Ingryd Carmona-Garcia; Nicola T Neto; Diana M Toro; Camilla N S Oliveira; Thais F C Fraga-Silva; Cristiane M Milanezi; Lilian C Rodrigues; Cassia F. S. L. Dias; Ana C Xavier; Giovanna S Porcel; Isabelle C Guarneri; Kamila Zaparoli; Caroline T Garbato; Jamille G M Argolo; Angelo A F Junior; Alessandro P de Amorim; Augusto M Degiovani; Dayane P da Silva; Debora C Nepomuceno; Rafael C da Silva; Leticia F Constant; Fatima M Ostini; Marley R Feitosa; Rogerio S Parra; Fernando C Vilar; Gilberto G Gaspar; Jose J R da Rocha; Omar Feres; Rita C C Barbieri; Fabiani G Frantz; Sandra R Maruyama; Elisa M S Russo; Angelina L Viana; Ana P M Fernandes; Isabel K F M Santos; Vania L D Bonato; Marcelo Dias-Baruffi; Adriana Malheiro; Ruxana T Sadikot; Cristina R B Cardoso; Lucia H Faccioli; Carlos A Sorgi

    doi:10.1101/2020.09.22.20199703 Date: 2020-09-23 Source: medRxiv

    Background: The uncontrolled inflammatory response plays a critical role in the novel coronavirus disease MESHD (COVID-19) and triggering receptor expressed on myeloid cells-1 (TREM-1) is thought to be intricate to inflammatory signal amplification. This study aims to investigate the association between soluble TREM-1 (sTREM-1) and COVID-19 as a prognostic biomarker to predict the disease severity, lethality and clinical management.Methods: We enrolled 91 patients with COVID-19 in domiciliary care (44 patients) or in hospital care (47 patients), who were classified after admission into mild, moderate, severe and critical groups according to their clinical scores. As non-COVID-19 control, 30 healthy volunteers were included. Data on demographic, comorbidities and baseline clinical characteristics were obtained from their medical and nurse records. Peripheral blood SERO samples were collected at admission and after hospitalization outcome to assess cytokine profile and sTREM-1 level by specific immunoassays SERO Results: Within COVID-19 patients, the highest severity was associated with the most significant elevated plasma SERO levels sTREM-1. Using receiver operating curve analysis (ROC), sTREM-1 was found to be predictive of disease severity (AUC= 0.988) and the best cut-off value for predicting in-hospital severity was [≥] 116.5 pg/mL with the sensitivity SERO for 93.3% and specificity for 95.8%. We also described the clinical characteristics of these patients and explored the correlation with markers of the disease aggravation. The levels of sTREM-1 were positively correlated with IL-6, IL-10, blood SERO neutrophils counts, and critical disease MESHD scoring (r= 0.68, p<0.0001). On the other hand, sTREM-1 level was significantly negative correlated with lymphocytes counting, and mild disease (r= -0.42, p<0.0001). Higher levels of sTREM-1 were related to poor outcome and death MESHD, patients who received dexamethasone tended to have lower sTREM-1 levels. Conclusion: Our results indicated that sTREM-1 in COVID-19 is associated with severe disease development and a prognostic marker for mortality. The use of severity biomarkers such as sTREM-1 together with patients clinical scores could improve the early recognition and monitoring of COVID-19 cases with higher risk of disease worsening. Key words: COVID-19; sTREM-1; Inflammation; Biomarker; Severity; Mortality.

    Model stability of COVID-19 mortality prediction with biomarkers

    Authors: Chenyan Huang; Xi Long; Zhuozhao Zhan; Edwin van den Heuvel

    doi:10.1101/2020.07.29.20161323 Date: 2020-07-30 Source: medRxiv

    Coronavirus disease MESHD 2019 (COVID-19) is an unprecedented and fast evolving pandemic, which has caused a large number of critically ill MESHD patients and deaths globally. It is an acute public health crisis leading to overloaded critical care capacity. Timely prediction of the clinical outcome ( death MESHD/survival) of hospital-admitted COVID-19 patients can provide early warnings to clinicians, allowing improved allocation of medical resources. In a recently published paper, an interpretable machine learning model was presented to predict the mortality of COVID-19 patients with blood SERO biomarkers, where the model was trained and tested on relatively small data sets. However, the model or performance SERO stability was not explored and assessed. By re-analyzing the data, we reveal that the reported mortality prediction performance SERO was likely over-optimistic and its uncertainty was underestimated or overlooked, with a large variability in predicting deaths.

    Seroprevalence SERO of anti-SARS-CoV-2 IgG antibodies SERO in Kenyan blood SERO donors

    Authors: Sophie Uyoga; Ifedayo M.O. Adetifa; Henry K. Karanja; James Nyagwange; James Tuju; Perpetual Wanjiku; Rashid Aman; Mercy Mwangangi; Patrick Amoth; Kadondi Kasera; Wangari Ng'ang'a; Charles Rombo; Christine K. Yegon; Khamisi Kithi; Elizabeth Odhiambo; Thomas Rotich; Irene Orgut; Sammy Kihara; Mark Otiende; Christian Bottomley; Zonia N. Mupe; Eunice W. Kagucia; Katherine Gallagher; Anthony Etyang; Shirine Voller; John Gitonga; Daisy Mugo; Charles N. Agoti; Edward Otieno; Leonard Ndwiga; Teresa Lambe; Daniel Wright; Edwine Barasa; Benjamin Tsofa; Philip Bejon; Lynette I. Ochola-Oyier; Ambrose Agweyu; J. Anthony G. Scott; George M Warimwe

    doi:10.1101/2020.07.27.20162693 Date: 2020-07-29 Source: medRxiv

    Background There are no data on SARS-CoV-2 seroprevalence SERO in Africa though the COVID-19 epidemic curve and reported mortality differ from patterns seen elsewhere. We estimated the anti- SARS-CoV-2 antibody SERO prevalence SERO among blood SERO donors in Kenya. Methods We measured anti-SARS-CoV-2 spike IgG prevalence SERO by ELISA SERO on residual blood SERO donor samples obtained between April 30 and June 16, 2020. Assay sensitivity SERO and specificity were 83% (95% CI 59, 96%) and 99.0% (95% CI 98.1, 99.5%), respectively. National seroprevalence SERO was estimated using Bayesian multilevel regression and post-stratification to account for non-random sampling with respect to age TRANS, sex and region, adjusted for assay performance SERO. Results Complete data were available for 3098 of 3174 donors, aged TRANS 15-64 years. By comparison with the Kenyan population, the sample over-represented males TRANS (82% versus 49%), adults TRANS aged TRANS 25-34 years (40% versus 27%) and residents of coastal Counties (49% versus 9%). Crude overall seroprevalence SERO was 5.6% (174/3098). Population-weighted, test-adjusted national seroprevalence SERO was 5.2% (95% CI 3.7, 7.1%). Seroprevalence SERO was highest in the 3 largest urban Counties; Mombasa (9.3% [95% CI 6.4, 13.2%)], Nairobi (8.5% [95% CI 4.9, 13.5%]) and Kisumu (6.5% [95% CI 3.3, 11.2%]). Conclusions We estimate that 1 in 20 adults TRANS in Kenya had SARS-CoV-2 antibodies SERO during the study period. By the median date of our survey, only 2093 COVID-19 cases and 71 deaths had been reported through the national screening system. This contrasts, by several orders of magnitude, with the numbers of cases and deaths MESHD reported in parts of Europe and America when seroprevalence SERO was similar.

    Genetic inhibition of interleukin-6 receptor signaling and Covid-19

    Authors: Jonas Bovijn; Cecilia M. Lindgren; Michael V. Holmes

    doi:10.1101/2020.07.17.20155242 Date: 2020-07-19 Source: medRxiv

    There are few effective therapeutic options for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection MESHD. Early evidence has suggested that IL-6R blockers may confer benefit, particularly in severe coronavirus disease MESHD 2019 (Covid-19). We leveraged large-scale human genetic data to investigate whether IL6-R blockade may confer therapeutic benefit in Covid-19. A genetic instrument consisting of seven genetic variants in or close to IL6R was recently shown to be linked to altered levels of c-reactive protein (CRP), fibrinogen, circulating IL-6 and soluble IL-6R, concordant to known effects of pharmacological IL-6R blockade. We investigated the effect of these IL6R variants on risk of hospitalization for Covid-19 and other SARS-CoV-2-related outcomes using data from The Covid-19 Host Genetics Initiative. The IL6R variants were strongly associated with serum SERO CRP levels in UK Biobank. Meta-analysis of scaled estimates revealed a lower risk of rheumatoid arthritis HP rheumatoid arthritis MESHD (OR 0.93 per 0.1 SD lower CRP, 95% CI, 0.90-0.96, P = 9.5 x 10-7), recapitulating this established indication for IL-6R blockers (e.g. tocilizumab and sarilumab). The IL-6R instrument was associated with lower risk of hospitalization for Covid-19 (OR 0.88 per 0.1 SD lower CRP, 95% CI, 0.78-0.99, P = 0.03). We found a consistent association when using a population-based control group (i.e. all non-cases; OR 0.91 per 0.1 SD lower CRP, 95% CI, 0.87-0.96, P = 4.9 x 10-4). Evaluation of further SARS-CoV-2-related outcomes suggested association with risk of SARS-CoV-2 infection MESHD, with no evidence of association with Covid-19 complicated by death MESHD or requiring respiratory support. We performed several sensitivity SERO analyses to evaluate the robustness of our findings. Our results serve as genetic evidence for the potential efficacy of IL-6R blockade in Covid-19. Ongoing large-scale RCTs of IL-6R blockers will be instrumental in identifying the settings, including stage of disease, in which these agents may be effective.

    Blood SERO parameters measured on admission as predictors of outcome for COVID-19; a prospective UK cohort study

    Authors: David T Arnold; Marie Attwood; Shaney Barratt; Karen Elvers; Anna Morley; Jorgen McKernon; Adrian Oates; Charmaine Donald; Alan Noel; Alasdair MacGowan; Nick A Maskell; Fergus Hamilton

    doi:10.1101/2020.06.25.20137935 Date: 2020-06-29 Source: medRxiv

    Abstract: Introduction: COVID-19 has an unpredictable clinical course so prognostic biomarkers would be invaluable when triaging patients on admission to hospital. Many biomarkers have been suggested using large observational datasets but sample timing is crucial to ensure prognostic relevance. The DISCOVER study prospectively recruited patients with COVID-19 admitted to a UK hospital and analysed a panel of putative prognostic biomarkers on the admission blood SERO sample to identify markers of poor outcome. Methods: Consecutive patients admitted to hospital with proven or clinicoradiological suspected COVID-19 were recruited. Admission bloods SERO were extracted from the clinical laboratory. A panel of biomarkers (IL-6, suPAR, KL-6, Troponin, Ferritin, LDH, BNP, Procalcitonin) were performed in addition to routinely performed markers (CRP, neutrophils, lymphocytes, neutrophil:lymphocyte ratio). Age TRANS, NEWS score and CURB-65 were included as comparators. All biomarkers were tested in logistic regression against a composite outcome of non-invasive ventilation, intensive care admission, or death MESHD, with Area Under the Curve (AUC) figures calculated. Results: 155 patients had 28-day outcomes at the time of analysis. CRP (AUC 0.51 ,CI:0.40-0.62), lymphocyte count (AUC 0.62 ,CI:0.51-0.72), and other routine markers did not predict the primary outcome. IL-6 (AUC: 0.78,0.65-0.89) and suPAR (AUC 0.77 ,CI: 0.66-0.85) showed some promise, but simple clinical features alone such as NEWS score (AUC: 0.74 ,0.64-0.83) or age TRANS (AUC: 0.70 ,0.61-0.78) performed nearly as well. Discussion: Admission blood SERO biomarkers have only moderate predictive value for predicting COVID-19 outcomes, while simple clinical features such as age TRANS and NEWS score outperform many biomarkers. IL-6 and suPAR had the best performance SERO, and further studies should validate these biomarkers in a prospective fashion.

    COVID-19 Outpatient Screening: a Prediction Score for Adverse Events

    Authors: Haoqi Sun; Aayushee Jain; Michael J Leone; Haitham S Alabsi; Laura N Brenner; Elissa Ye; Wendong Ge; Yu-Ping Shao; Christine L Boutros; Ruopeng Wang; Ryan A Tesh; Colin Magdamo; Sarah I Collens; Wolfgang Ganglberger; Ingrid V Bassett; James B Meigs; Jayashree Kalpathy-Cramer; Matthew D Li; Jacqueline T Chu; Michael Dougan; Lawrence Stratton; Jonathan Rosand; Bruce Fischl; Sudeshna Das; Shibani S Mukerji; Gregory K Robbins; M. Brandon Westover

    doi:10.1101/2020.06.17.20134262 Date: 2020-06-22 Source: medRxiv

    Background. We sought to develop an automatable score to predict hospitalization, critical illness MESHD, or death MESHD in patients at risk for COVID-19 presenting for urgent care during the Massachusetts outbreak. Methods. Single-center study of adult TRANS outpatients seen in respiratory illness MESHD clinics (RICs) or the emergency department (ED), including development (n = 9381, March 7-May 2) and prospective (n = 2205, May 3-14) cohorts. Data was queried from Partners Enterprise Data Warehouse. Outcomes were hospitalization, critical illness MESHD or death MESHD within 7 days. We developed the COVID-19 Acuity Score (CoVA) using automatically extracted data from the electronic medical record and learning-to-rank ordinal logistic regression modeling. Calibration was assessed using predicted-to-observed event ratio (E/O). Discrimination was assessed by C-statistics (AUC). Results. In the development cohort, 27.3%, 7.2%, and 1.1% of patients experienced hospitalization, critical illness MESHD, or death MESHD, respectively; and in the prospective cohort, 26.1%, 6.3%, and 0.5%. CoVA showed excellent performance SERO in the development cohort (concurrent validation) for hospitalization (E/O: 1.00, AUC: 0.80); for critical illness (E/O: 1.00, AUC: 0.82); and for death (E/O: 1.00, AUC: 0.87). Performance SERO in the prospective cohort (prospective validation) was similar for hospitalization (E/O: 1.01, AUC: 0.76); for critical illness (E/O 1.03, AUC: 0.79); and for death (E/O: 1.63, AUC=0.93). Among 30 predictors, the top five were age TRANS, diastolic blood pressure MESHD blood SERO pressure, blood SERO oxygen saturation, COVID-19 testing status, and respiratory rate. Conclusions. CoVA is a prospectively validated automatable score to assessing risk for adverse outcomes related to COVID-19 infection MESHD in the outpatient setting.

    Can corticosteroids improve the outcomes of patients with Covid-19? A retrospective cohort study of patients within and outside the epicentre

    Authors: He Yu; Pei-Jun Li; Ting Wang; Rong Yao; Zhong Ni; Huan Yang; Bin-Miao Liang; Dan Liu; Feng-Ming Luo; Hong Chen; Zongan Liang

    doi:10.21203/rs.3.rs-32279/v1 Date: 2020-05-29 Source: ResearchSquare

    Background The novel coronavirus disease MESHD 2019 (Covid-19) has been a worldwide pandemic with more than 300,000 deaths. Corticosteroids have been used in some patients with severe Covid-19 in order to control the systemic inflammation MESHD or cytokine storm, however, their effects and safety have not yet been elucidated.Methods Patients with confirmed Covid-19 were retrospectively included from both the epicentre and out of the epicentre. Patients were classified into two groups according to the use of systemic corticosteroids, and the mortality and the rate of virus clearance were compared between the two groups. In addition, independent factors associated with death MESHD after corticosteroids treatment were also identified.Results A total of 775 patients were included in our final analysis, of which 238 (30.7%) patients received systemic corticosteroids treatment. Compared with patients without corticosteroids treatment, patients with corticosteroids treatment had significantly higher mortality (19.3% vs. 3.7%, P < 0.001) and lower rate of virus clearance (43.2% vs. 66.7%, P < 0.001) although along with increase of SpO2/FiO2 and blood SERO lymphocytes in patients with severe Covid-19. Corticosteroids treatment was associated with longer hospital length of stays and delayed virus clearance time. In patients with corticosteroids treatment, blood SERO lymphocytes (odds ratio (OR) 0.792, 95% confidence interval (CI) 0.672–0.932, P = 0.005) and creatine kinase (CK) (OR 1.006, 95%CI 1.000-1.012, P = 0.038) were independent risk factors associated with death MESHD, with a sensitivity SERO of 90.91% and 44.44% and a specificity of 70.75% and 94.05%, respectively.Conclusions In patients with Covid-19, corticosteroids treatment is associated with increased mortality and reduced rate of virus clearance.

    THE LOW-HARM SCORE FOR PREDICTING MORTALITY IN PATIENTS DIAGNOSED WITH COVID-19: A MULTICENTRIC VALIDATION STUDY

    Authors: Adrian Soto-Mota; Braulio A. Marfil Garza; Erick Martinez Rodriguez; Jose Omar Barreto Rodriguez; Alicia Estela Lopez Romo; Paolo Alberti Minutti; Juan Vicente Alejandre Loya; Felix Emmanuel Perez Talavera; Freddy Jose Avila-Cervera; Adriana Nohemi Velazquez Burciaga; Oscar Morado Aramburo; Luis Alberto Pina Olguin; Adrian Soto-Rodriguez; Andres Castaneda Prado; Patricio Santillan-Doherty; Juan O Galindo Galindo; Daniel Hernandez Gordillo; Juan Gutierrez Mejia

    doi:10.1101/2020.05.26.20111120 Date: 2020-05-27 Source: medRxiv

    ABSTRACT - Importance: Many COVID-19 prognostic factors for disease severity have been identified and many scores have already been proposed to predict death MESHD and other outcomes. However, hospitals in developing countries often cannot measure some of the variables that have been reported as useful. - Objective: To assess the sensitivity SERO, specificity, and predictive values of the novel LOW-HARM score ( Lymphopenia HP Lymphopenia MESHD, Oxygen saturation, White blood SERO cells, Hypertension HP Hypertension MESHD, Age TRANS, Renal injury MESHD, and Myocardial injury MESHD). - Design: Demographic and clinical data from patients with known clinical outcomes ( death MESHD or discharge) was obtained. Patients were grouped according to their outcome. The LOW-HARM score was calculated for each patient and its distribution, potential cut-off values and demographic data were compared. - Setting: Thirteen hospitals in ten different cities in Mexico. - Participants: Data from 438 patients was collected. A total of 400 (200 per group) was included in the analysis. - Exposure: All patients had an infection with SARS-CoV-2 confirmed by PCR. - Main Outcome: The sensitivity SERO, specificity, and predictive values of different cut-offs of the LOW-HARM score to predict death. - Results: Mean scores at admission and their distributions were significantly lower in patients who were discharged compared to those who died during their hospitalization 10 (SD: 17) vs 71 (SD: 27). The overall AUC of the model was 95%. A cut-off > 65 points had a specificity of 98% and a positive predictive value SERO of 96%. More than a third of the cases (34%) in the sample had a LOW-HARM score > 65 points. - Conclusions and relevance: The LOW-HARM score measured at admission is highly specific and useful for predicting mortality. It is easy to calculate and can be updated with individual clinical progression. The proposed cut-off can assist the decision-making process in more than a third of the hospital admissions.

    Diagnostic Performance SERO of a Blood SERO Urea Nitrogen to Creatinine Ratio-Based Nomogram for Predicting in-Hospital Mortality in COVID-19 Patients

    Authors: Qingquan Liu; Yiru Wang; Xuecheng Zhao; Lixuan Wang; Feng Liu; Yongman Lv; Tao Wang; Dawei Ye

    doi:10.21203/rs.3.rs-29948/v1 Date: 2020-05-19 Source: ResearchSquare

    Background: The novel coronavirus disease MESHD (COVID-19) is leading to high morbidity and mortality. This study aimed to test whether blood SERO urea nitrogen-to-creatinine ratios (BCR) is a predictor of poor prognosis in patients with COVID-19. Method: From 9,165 generally healthy subjects, we calculated ranges of “normal” BCR values. 416 COVID-19 patients were randomly assigned to training cohort and validation cohort contained 337, 79 patients, respectively. The prognostic ability of abnormal BCR range was assessed using a Logistic regression. Development a nomogram for predicting in-hospital mortality incorporated age TRANS, sex and BCR. The model discrimination was assessed using the calibration curves and concordance index in training and validation cohort. The predictive accuracy and clinical values of the nomogram was measured by decision curve analysis (DCA) and clinical impact curve analysis (CICA). Results: Among 337 COVID-19 patients, 13.4% and 11.3% were classified into higher and lower than normal range group, respectively. The BCR was identified as an independent risks factor for death MESHD in COVID-19 patients (P<0.0001), with area under the curve (AUC) 0.768; 95%CI: 0.717-0.819). Kaplan-Meier curves for all-cause mortality outcomes showed that patients with above normal range of BCR had worse prognosis (p<0.0001). Logistic regression analysis revealed that BCR above the normal range was independently associated with death MESHD in COVID-19 patients (Odds ratio 7.54; 95%CI: 1.55-36.66; P=0.012). ROC curves showed that the nomogram had good discrimination in the training cohort (AUC 0.838; 95%CI 0.795–0.880) and the validation cohort (AUC 0.929; 95%CI 0.869-0.989). Using maximum Youden index, the cutoff values of 59.8 points, the sensitivity SERO and specificity were 75.4% and 81%. The calibration curves showed good agreement between nomogram prediction and actual observation. DCA and CICA indicated the clinical usefulness of the prediction nomogram. Conclusion: BCR was a useful prognostic factor for COVID-19 patients. Development of an individualized prediction nomogram BCR-based, which can effectively predict the risk of mortality, and then, help clinicians to improve individual treatment, make clinical decisions timely and early.

    Supplementing the National Early Warning Score (NEWS2) for anticipating early deterioration among patients with COVID-19 infection

    Authors: Ewan Carr; Rebecca Bendayan; Daniel Bean; Matthew Stammers; Wenjuan Wang; Huayu Zhang; Thomas Searle; Zeljko Kraljevic; Anthony Shek; Hang T T Phan; Walter Muruet; Anthony J Shinton; Ting Shi; Xin Zhang; Andrew Pickles; Daniel Stahl; Rosita Zakeri; Kevin O'Gallagher; Amos Folarin; Lukasz Roguski; Florina Borca; James Batchelor; Xiaodong Wu; Jiaxing Sun; Ashwin Pinto; Bruce Guthrie; Cormac Breen; Abdel Douiri; Honghan Wu; Vasa Curcin; James T Teo; Ajay Shah; Richard Dobson

    doi:10.1101/2020.04.24.20078006 Date: 2020-04-29 Source: medRxiv

    Objectives: To evaluate the National Early Warning Score (NEWS2), currently recommended in the UK for risk-stratification of severe COVID-19 outcomes, and subsequently identify and validate a minimal set of common parameters taken at hospital admission that improve the score. Design: Retrospective observational cohort with internal and multi-hospital external validation. Setting: Secondary care. Interventions: Not applicable. Participants: Training and temporal external validation cohorts comprised 1464 patients admitted to King's College Hospital NHS Foundation Trust (KCH) with COVID-19 disease from 1st March to 30th April 2020. External validation cohorts included 3869 patients from two UK NHS Trusts (Guys and St Thomas' Hospitals, GSTT and University Hospitals Southampton, UHS) and two hospitals in Wuhan, China (Wuhan Sixth Hospital and Taikang Tongji Hospital). Main outcome measures: The primary outcome was patient status at 14 days after symptom onset TRANS categorised as severe disease (transferred to intensive care unit or death MESHD). Age TRANS, physiological measures, blood SERO biomarkers, sex, ethnicity and comorbidities ( hypertension HP hypertension MESHD, diabetes MESHD, cardiovascular, respiratory and kidney diseases MESHD) were included. Results: NEWS2 score on admission was a weak predictor of severe COVID-19 infection MESHD (AUC = 0.628). Adding age TRANS and common blood SERO tests (CRP, neutrophil count, estimated GFR and albumin) provided substantial improvements to a risk stratification model, particularly in relation to sensitivity SERO, but performance SERO was only moderate (AUC = 0.753). Improvement over NEWS2 remained robust and generalisable in GSTT (AUC = 0.817), UHS (AUC = 0.835) and Wuhan hospitals (AUC = 0.918). Conclusions: Adding age TRANS and a minimal set of blood SERO parameters to NEWS2 improves the detection of patients likely to develop severe COVID-19 outcomes. This finding was replicated across NHS and non-UK hospitals. Adding a few common parameters to a pre-existing acuity score allows rapid and easy implementation of this risk-scoring system.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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