Corpus overview


MeSH Disease

Human Phenotype


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    Estimating Risk of Mechanical Ventilation MESHD and Mortality Among Adult TRANS COVID-19 patients Admitted to Mass General Brigham: The VICE and DICE Scores

    Authors: Christopher J Nicholson; Luke Wooster; Haakon H Sigurslid; Rebecca F Li; Wanlin Jiang; Wenjie Tian; Christian Lino Cardenas; Rajeev Malhotra

    doi:10.1101/2020.09.14.20194670 Date: 2020-09-17 Source: medRxiv

    Background: Risk stratification of COVID-19 patients upon hospital admission is key for their successful treatment and efficient utilization of hospital resources. Objective: To evaluate the risk factors associated with ventilation need and mortality. Design, setting and participants: We established a retrospective cohort of COVID-19 patients from Mass General Brigham hospitals. Demographic, clinical, and admission laboratory data were obtained from electronic medical records of patients admitted to hospital with laboratory-confirmed COVID-19 before May 19th, 2020. Using patients admitted to Massachusetts General Hospital (MGH, derivation cohort), multivariable logistic regression analyses were used to construct the Ventilation in COVID Estimator (VICE) and Death MESHD in COVID Estimator (DICE) risk scores. Measurements: The primary outcomes were ventilation status and death MESHD. Results: The entire cohort included 1042 patients (median age TRANS, 64 years; 56.8% male TRANS). The derivation and validation cohorts for the risk scores included 578 and 464 patients, respectively. We found seven factors to be independently predictive for ventilation requirement ( diabetes mellitus HP diabetes mellitus MESHD, dyspnea HP dyspnea MESHD, alanine aminotransferase, troponin, C-reactive protein, neutrophil-lymphocyte ratio, and lactate dehydrogenase), and 10 factors to be predictors of in-hospital mortality ( age TRANS, sex, diabetes mellitus HP diabetes mellitus MESHD, chronic statin use, albumin, C-reactive protein, neutrophil-lymphocyte ratio, mean corpuscular volume, platelet count, and procalcitonin). Using these factors, we constructed the VICE and DICE risk scores, which performed with C-statistics of at least 0.8 in our cohorts. Importantly, the chronic use of a statin was associated with protection against death MESHD due to COVID-19. The VICE and DICE score calculators have been placed on an interactive website freely available to the public ( Limitations: One potential limitation is the modest sample sizes in both our derivation and validation cohorts. Conclusion: The risk scores developed in this study may help clinicians more appropriately determine which COVID-19 patients will need to be managed with greater intensity.

    Predicting clinical outcome with phenotypic clusters in COVID-19 pneumonia HP pneumonia MESHD: 2 an analysis of 12,066 hospitalized patients from the Spanish registry SEMI-3 COVID-19.

    Authors: Manuel Rubio-Rivas; Xavier Corbella; Jose Maria Mora-Lujan; Jose Loureiro Amigo; Almudena Lopez Sampalo; Carmen Yera Bergua; Pedro Jesus Esteve Atienzar; Luis Felipe Diez Garcia; Ruth Gonzalez Ferrer; Susana Plaza Canteli; Antia Perez Pineiro; Begona Cortes Rodriguez; Leyre Jorquer Vidal; Ignacio Perez Catalan; Marta Leon Tellez; Jose Angel Martin Oterino; Maria Candelaria Martin Gonzalez; Jose Luis Serrano Carrillo de Albornoz; Eva Garcia Sardon; Jose Nicolas Alcala Pedrajas; Anabel Martin Urda Diez Canseco; Maria Jose Esteban Giner; Pablo Telleria Gomez; Ricardo Gomez Huelgas; Jose Manuel Ramos Rincon; Nina la Cour Freiesleben; Henriette Svarre Nielsen

    doi:10.1101/2020.09.14.20193995 Date: 2020-09-15 Source: medRxiv

    (1) Background: This study aims to identify different clinical phenotypes in COVID-19 88 pneumonia HP pneumonia MESHD using cluster analysis and to assess the prognostic impact among identified clusters in 89 such patients. (2) Methods: Cluster analysis including 11 phenotypic variables was performed in a 90 large cohort of 12,066 COVID-19 patients, collected and followed-up from March 1, to July 31, 2020, 91 from the nationwide Spanish SEMI-COVID-19 Registry. (3) Results: Of the total of 12,066 patients 92 included in the study, most were males TRANS (7,052, 58.5%) and Caucasian (10,635, 89.5%), with a mean 93 age TRANS at diagnosis of 67 years (SD 16). The main pre-admission comorbidities were arterial 94 hypertension HP hypertension MESHD (6,030, 50%), hyperlipidemia HP hyperlipidemia MESHD (4,741, 39.4%) and diabetes mellitus HP diabetes mellitus MESHD (2,309, 19.2%). The 95 average number of days from COVID-19 symptom onset TRANS to hospital admission was 6.7 days (SD 7). 96 The triad of fever HP fever MESHD, cough HP cough MESHD, and dyspnea HP dyspnea MESHD was present almost uniformly in all 4 clinical phenotypes 97 identified by clustering. Cluster C1 (8,737 patients, 72.4%) was the largest, and comprised patients 98 with the triad alone. Cluster C2 (1,196 patients, 9.9%) also presented with ageusia and anosmia MESHD anosmia HP; 99 cluster C3 (880 patients, 7.3%) also had arthromyalgia, headache HP headache MESHD, and sore throat; and cluster C4 100 (1,253 patients, 10.4%) also manifested with diarrhea HP diarrhea MESHD, vomiting HP vomiting MESHD, and abdominal pain HP abdominal pain MESHD. Compared to 101 each other, cluster C1 presented the highest in-hospital mortality (24.1% vs. 4.3% vs. 14.7% vs. 102 18.6%; p<0.001). The multivariate study identified phenotypic clusters as an independent factor for 103 in-hospital death. (4) Conclusion: The present study identified 4 phenotypic clusters in patients with 104 COVID-19 pneumonia HP pneumonia MESHD, which predicted the in-hospital prognosis of clinical outcomes.

    Risk factors for SARS-CoV-2 infection MESHD, hospitalisation, and death in Catalonia MESHD, Spain: a population-based cross-sectional study

    Authors: Judit Villar-Garcia; Rosa Maria Vivanco-Hidalgo; Montserrat Cleries; Elisenda Martinez; David Monterde; Pol Perez-Sust; Luis Garcia-Eroles; Carol Sais; Montserrat Moharra; Emili Vela; Jochen Lennerz; Hetal Desai Marble; Lauren L. Ritterhouse; Julie Batten; N. Zeke Georgantas; Rebecca Pellerin; Sylvia Signorelli; Julia Thierauf; Molly Kemball; Christian Happi; Donald S. Grant; Daouda Ndiaye; Katherine J. Siddle; Samar B Mehta; Jason B. Harris; Edward T Ryan; Virginia M. Pierce; Regina C LaRocque; Jacob Lemieux; Pardis Sabeti; Eric Rosenberg; John Branda; Sarah E Turbett; Gail Carson; Malcolm G Semple; Janet T Scott

    doi:10.1101/2020.08.26.20182303 Date: 2020-09-01 Source: medRxiv

    OBJECTIVE To identify the different subpopulations that are susceptible for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection MESHD and hospitalisation or death MESHD due to coronavirus disease MESHD 2019 (COVID-19) in Catalonia, Spain. DESIGN Cross-sectional study. SETTING Data collected from the Catalan Health Surveillance System (CatSalut) in Catalonia, a region of Spain. PARTICIPANTS Using data collected between 1 March and 1 June 2020, we conducted the following comparative analyses: people infected by SARS-CoV-2 (328 892) vs Catalonia's entire population (7 699 568); COVID-19 cases who required hospitalisation (37 638) vs cases who did not require hospitalisation (291 254); and COVID-19 cases who died during the study period vs cases who did not die during the study period (12 287). MAIN OUTCOME MEASURES Three clinical outcomes related to COVID-19 ( infection MESHD, hospitalisation, or death MESHD). We analysed sociodemographic and environment variables (such as residing in a nursing home) and the presence of previous comorbidities. RESULTS A total of 328 892 cases were considered to be infected with SARS-CoV-2 (4.27% of total population). The main risk factors for the diagnostic were: female TRANS gender TRANS (risk ratio [RR] =1.49; 95% confidence interval [95% CI] =1.48-1.50), age TRANS (45-64 years old; RR=1.02; 95% CI=1.01-1.03), high comorbidity burden (GMA index) (RR=3.03; 95% CI=2.97-3.09), reside in a nursing home (RR=11.82; 95% CI=11.66-11.99), and smoking (RR=1.06; 95% CI=1.05-1.07). During the study period, there were 37 638 (11.4 %) hospitalisations due to COVID-19, and the risk factors were: male TRANS gender TRANS (RR=1.45; 95% CI=1.43-1.48), age TRANS > 65 (RR=2.38; 95% CI=2.28-2.48), very low individual income (RR=1.03; 95% CI=0.97-1.08), and high burden of comorbidities (GMA index) (RR=5.15; 95% CI=4.89-5.42). The individual comorbidities with higher burden were obesity HP obesity MESHD (RR=1.23; 95% CI=1.20-1.25), chronic obstructive pulmonary disease HP chronic obstructive pulmonary disease MESHD (RR=1.19; 95% CI=1.15-1.22), heart failure MESHD (RR=1.19; 95% CI=1.16-1.22), diabetes mellitus HP diabetes mellitus MESHD (RR=1.07; 95% CI=1.04-1.10), and neuro-psychiatric MESHD comorbidities (RR=1.06; 95% CI=1.03-1.10). A total of 12 287 deaths (3.73%) were attributed to COVID-19, and the main risk factors were: male TRANS gender TRANS (RR=1.73; 95% CI=1.67-1.81), age TRANS > 65 (RR=37.45; 95% CI=29.23-47.93), residing in a nursing home (RR=9.22; 95% CI=8.81-9.65), and high burden of comorbidities (GMA index) (RR=5.25; 95% CI=4.60-6.00). The individual comorbidities with higher burden were: heart failure MESHD (RR=1.21; 95% CI=1.16-1.22), chronic kidney disease HP chronic kidney disease MESHD (RR=1.17; 95% CI=1.13-1.22), and diabetes mellitus HP diabetes mellitus MESHD (RR=1.10; 95% CI=1.06-1.14). These results did not change significantly when we considered only PCR-positive patients. CONCLUSIONS Female TRANS gender TRANS, age TRANS between 45 to 64 years old, high burden of comorbidities, and factors related to environment (nursing home) play a relevant role in SARS-CoV-2 infection MESHD and transmission TRANS. In addition, we found risk factors for hospitalisation and death MESHD due to COVID-19 that had not been described to date, including comorbidity burden, neuro-psychiatric disorders MESHD, and very low individual income. This study supports interventions for transmission TRANS control beyond stratify-and-shield strategies focused only on protecting those at risk of death. Future COVID-19 studies should examine the role of gender TRANS, the burden of comorbidities, and socioeconomic status in disease transmission TRANS, and should determine its relationship to workplaces, especially healthcare centres and nursing homes.

    Obesity HP, old age TRANS and frailty are the true risk factors for COVID-19 mortality and not chronic disease MESHD or ethnicity in Croydon.

    Authors: Zinu Philipose; Nadia Smati; Chun Shing Jefferson Wong; Karen Aspey; Michael Anthony Mendall; Christopher Thouvenel; Kennidy K Takehara; Julie Eggenberger; Emily A Hemann; Hayley R Waterman; Mitchell L Fahning; Yu Chen; Jennifer Rathe; Caleb Stokes; Samuel Wrenn; Brooke Fiala; Lauren P Carter; Jessica A Hamerman; Neil P King; Michael Gale; Daniel J Campbell; David Rawlings; Marion Pepper

    doi:10.1101/2020.08.12.20156257 Date: 2020-08-14 Source: medRxiv

    Background: Coronavirus-19 (COVID-19) mortality in hospitalised patients is strongly associated with old age TRANS, nursing home residence, male TRANS sex and obesity HP obesity MESHD, with a more controversial association with ethnicity and chronic diseases MESHD, in particular diabetes mellitus MESHD diabetes mellitus HP. Further complicating the evaluation of the independent impacts of these risk factors is the failure to control for frailty in the published studies thus far. Aim: To determine the true risk factors for mortality in patients confirmed to have COVID-19 in Croydon needing hospital admission and to evaluate the independence of these risk factors in this group after adjusting for body mass index (BMI) and frailty. Methods: This observational study retrospectively reviewed hospital electronic medical records of 466 consecutive patients who were admitted to Croydon University Hospital confirmed positive by rapid PCR test from 11th March 2020 to 9th April 2020. Statistical analysis was performed by multiple unconditional and univariate logistic regression. Results: After multivariate analysis, male TRANS sex [OR 1.44 (CI 0.92-2.40)], age TRANS (per year) [OR 1.07 (CI 1.05-1.09)], morbid obesity HP obesity MESHD (BMI > 40 kg/m2 vs reference BMI 18.5-24.9 kg/m2 ) [OR 14.8 (CI 5.25-41.8)], and nursing home residence (OR 3.01 (CI 1.56-5.79) were independently associated with COVID-19 mortality with no statistically significant association found with chronic diseases MESHD or ethnicity. In the non-nursing home population, after adjusting for age TRANS and sex, the odds ratio for type 2 diabetes mellitus MESHD diabetes mellitus HP ( T2DM MESHD) as a risk factor was 1.64 (CI 1.03-2.61, p = 0.03) and was and was attenuated to 1.30 (CI 0.78-2.18)) after controlling for BMI; the association of mortality with male TRANS sex was strengthened [OR 1.66 (CI 0.96-2.87)] and that for ethnic minority patients was weakened [South Asians [from OR 1.30 (CI 0.67-2.53)) to OR 1.21 (CI 0.60-2.46)]; African Caribbeans [from OR 1.24 (CI 0.65-2.34) to OR 1.16 (CI 0.58-2.30)]. There was a borderline but potentially large protective effect (p= 0.09) in patients who were on anticoagulation drugs prior to admission [OR 0.56 (CI 0.28-1.11)]. Conclusion: Our study found no significant effect of ethnicity and chronic diseases as independent risk factors on COVID-19 mortality in Croydon population whereas male TRANS sex, high BMI, old age TRANS and frailty were found to be independent risk factors. Routine prophylactic treatment with anticoagulant drugs in the high-risk COVID-19 population warrants further prompt investigation.

    Severe COVID-19 and Diabetes MESHD: A Retrospective Cohort Study from Three London Teaching Hospitals

    Authors: Chioma Izzi-Engbeaya; Walter Distaso; Anjali Amin; Wei Yang; Oluwagbemiga Idowu; Julia S Kenkre; Ronak J Shah; Evelina Woin; Christine Shi; Nael Alavi; Hala Bedri; Niamh Brady; Sophie Blackburn; Martina Leczycka; Sanya Patel; Elizaveta Sokol; Edward Toke-Bjolgerud; Ambreen Qayum; Mariana Abdel-Malek; David C D Hope; Nick S Oliver; Vasiliki Bravis; Shivani Misra; Tricia M Tan; Neil Hill; Victoria Salem; Dario S Zamboni; Rodrigo C Santana; Fernando C Vilar; Paulo Louzada-Junior; Rene D R Oliveira

    doi:10.1101/2020.08.07.20160275 Date: 2020-08-11 Source: medRxiv

    Patients with diabetes mellitus HP diabetes mellitus MESHD admitted to hospital with COVID-19 caused by infection with the novel coronavirus (SARS-CoV-2) have poorer outcomes. However, the drivers for this are not fully elucidated. We performed a retrospective cohort study, including detailed pre-hospital and presenting clinical and biochemical factors of 889 patients diagnosed with COVID-19 in three constituent hospitals of a large London NHS Trust. 62% of patients with severe COVID-19 were of non-White ethnic backgrounds and the prevalence SERO of diabetes MESHD was 38%. 323 (36%) patients met the primary outcome of death MESHD or admission to the intensive care unit (ICU) within 30 days of diagnosis. Male TRANS gender TRANS, advancing age TRANS and the Clinical Frailty Scale, an established measure of multimorbidity, independently predicted poor outcomes on multivariate analysis. Diabetes MESHD did not confer an independent risk for adverse outcomes in COVID-19, although patients with diabetes MESHD and ischaemic heart disease MESHD were at particular risk. Additional risk factors which significantly and independently associated with poorer outcomes in patients with diabetes MESHD were age TRANS, male TRANS gender TRANS and lower platelet count. Antiplatelet medication was associated with a lower risk of death MESHD/ICU admission and should be evaluated in randomised clinical trials amongst high risk patient groups.

    Effectiveness of Mid-Regional Pro-Adrenomedullin (MR-proADM) as Prognostic Marker in COVID-19 Critically MESHD Ill Patients: an Observational Prospective Study

    Authors: Giorgia Montrucchio; Gabriele Sales; Francesca Rumbolo; Filippo Palmesino; Vito Fanelli; Rosario Urbino; Claudia Filippini; Giulio Mengozzi; Luca Brazzi

    doi:10.21203/ Date: 2020-08-10 Source: ResearchSquare

    Background Due to the lack of validated biomarkers to predict disease progression and mortality in COVID-19 ICU-patients, we tested the effectiveness of mid-regional pro-adrenomedullin (MR-proADM) in comparison to C-reactive protein (CRP), procalcitonin (PCT), D-dimer, lactate dehydrogenase (LDH) in predicting outcome.Methods All consecutive COVID-19 adult TRANS patients admitted between March and June 2020 to the ICU of the ‘Città della Salute e della Scienza’ hospital in Turin (Italy) were enrolled. MR-proADM, clinical and routine laboratory test were measured within 48 hours from ICU admission, on day 3, 7 and 14. Survival curves difference with MR-proADM cut-off set to 1.8 nmol/L were tested using log-rank test. Predictive ability was compared using area under the curve and 95% confidence interval of different receiver-operating characteristics curves. Potential confounding effects were tested using a logistic regression model. Results Fifty-seven patients were enrolled. ICU and overall mortality were 54.4%. Within the first 24 hours, lymphocytopenia MESHD was present in 86%; increased D-dimer and CRP levels were found in 84.2% and 87.7% respectively, while PCT values higher than 0.5 μg/L were observed in 47.4%. MR-proADM, CRP and LDH were significantly different between surviving and non-surviving patients and over time, while PCT, D-dimer and NT-pro-BNP did not show any difference between the groups and over time; lymphocytes count was different between surviving and non-surviving patients only.MR-proADM was higher in dying patients (2.65+2.33vs1.18+0.47, p=0.0001) and a higher mortality characterized patients with MR-proADM exceeding 1.8 nmol/L (p=0.0157). The logistic regression model adjusted for age TRANS, gender TRANS, cardiovascular disease MESHD, diabetes mellitus HP diabetes mellitus MESHD and PCT values confirmed an odds ratio equal to 10.274 (95%CI 1.970-53.578) (p=0.0057) for MR-proADM higher than 1.8 nmol/L and equal to 22.206 (95%CI 1.56-316.960) (p=0.0223) for cardiovascular disease MESHD. Overall, MR-proADM was found to have the best predictive ability (AUC=0.846 – 95%CI 0.779-0.899).Conclusions In COVID-19 ICU-patients, MR-proADM seems able to provide a more precise stratification of disease severity and mortality risk than other biomarkers. Repeated MR-proADM measurement may support a rapid and effective decision-making. Further studies are needed to better explain the mechanisms responsible of the increase in MR-proADM observed in COVID-19 patients.

    Impact of tocilizumab administration on mortality in severe COVID-19

    Authors: Andrew Tsai; Oumou Diawara; Ronald G Nahass; Luigi Brunetti

    doi:10.1101/2020.07.30.20114959 Date: 2020-08-02 Source: medRxiv

    Background The novel coronavirus disease MESHD 2019 (COVID-19) worldwide pandemic has placed a significant burden on hospitals and healthcare providers. The immune response to this disease is thought to lead to a cytokine storm, which contributes to the severity of illness. There is an urgent need to confirm whether the use of tocilizumab provides a benefit in individuals with COVID-19. Methods A single-center propensity-score matched cohort study, including all consecutive COVID-19 patients, admitted to the medical center who were either discharged from the medical center or expired between March 1, 2020, and May 5, 2020, was performed. Patients were stratified according to the receipt of tocilizumab for cytokine storm and matched to controls using propensity scores. The primary outcome was in-hospital mortality. Results A total of 132 patients were included in the matched dataset (tocilizumab=66; standard of care=66). Approximately 73% of the patients were male TRANS. Hypertension HP Hypertension MESHD (55%), diabetes mellitus HP diabetes mellitus MESHD (31%), and chronic pulmonary disease MESHD (15%) were the most common comorbidities present. There were 18 deaths (27.3%) in the tocilizumab group and 18 deaths (27.3%) in the standard of care group (odds ratio, 1.0; 95% confidence interval, 0.465 - 2.151; p=1.00). Advanced age TRANS, history of myocardial infarction HP myocardial infarction MESHD, dementia HP dementia MESHD, chronic pulmonary disease MESHD, heart failure MESHD, and malignancy MESHD were significantly more common in patients who died. Interpretation The current analysis does not support the use of tocilizumab for the management of cytokine storm in patients with COVID-19. Use of this therapeutic agent should be limited to the context of a clinical trial until more evidence is available.

    Clinical manifestations of patients with Coronavirus Disease MESHD 2019 (COVID- 19) attending at hospitals in Bangladesh

    Authors: Md. Shahed Morshed; Abdullah Al Mosabbir; Prodipta Chowdhury; Sheikh Mohammad Ashadullah; Mohammad Sorowar Hossain

    doi:10.1101/2020.07.30.20165100 Date: 2020-08-01 Source: medRxiv

    Bangladesh is in the rising phase of the ongoing pandemic of the coronavirus disease MESHD 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 MESHD (SARS-CoV-2). The scientific literature on clinical manifestations of COVID-19 patients from Bangladesh is scarce. This study aimed to report the sociodemographic and clinical characteristics of patients with COVID-19 in Bangladesh. We conducted a cross-sectional study at three dedicated COVID-19 hospitals. The severity of the COVID-19 cases was assessed based on the WHO interim guidance. Data were collected only from non-critical COVID-19 patients as critical patients required immediate intensive care admission making them unable to respond to the questions. A total of 103 RT-PCR confirmed non-critical COVID-19 patients were enrolled. Most of the patients (71.8%) were male TRANS. Mild, moderate and severe illness were assessed in 74.76%, 9.71% and 15.53% of patients respectively. Nearly 52.4% of patients had a co-morbidity, with hypertension HP hypertension MESHD being the most common (34%), followed by diabetes mellitus HP diabetes mellitus MESHD (21.4%) and ischemic MESHD heart disease MESHD (9.7%). Fever HP Fever MESHD (78.6%), weakness MESHD (68%) and cough HP (44.7%) were the most common clinical manifestations. Other common symptoms included loss of appetite (37.9%), difficulty in breathing (37.9%), altered sensation of taste or smell (35.0%), headache HP headache MESHD (32%) and body ache MESHD (32%). The median time from onset of symptom TRANS to attending hospitals was 7 days (IQR 4-10). This study will help both the clinicians and epidemiologists to understand the magnitude and clinical spectrum of COVID-19 patients in Bangladesh.

    COVID-19 and Guillain-Barre Syndrome - a Case report

    Authors: Amira Sidig; Khabab Abbasher; Mutaz F. Digna; Mohamed Elsayed; Hussien Abbasher; Mohammed Abbasher; Abbasher Hussien

    doi:10.21203/ Date: 2020-07-24 Source: ResearchSquare

    Coronaviruses are a family of related viruses that cause diseases in mammals and avians. Guillain-Barre syndrome MESHD is a rare disorder in which the body's immune system attacks peripheral nerves.The case:A 65 years old Sudanese male TRANS with no diabetes mellitus HP diabetes mellitus MESHD or hypertension HP hypertension MESHD present to the clinic; On examination, he has upper and lower limb weakness MESHD ( quadriplegia MESHD). The condition was preceded by upper respiratory tract infection HP respiratory tract infection MESHD. Chest X-ray showed features of pneumonia HP pneumonia MESHD Chest CT scan showed multiple bilateral ground-glass opacities and consolidation typical of COVID-19 pneumonia HP pneumonia MESHD. Brain MRI was normal. The COVID-19 nasal swab test was positive. Nerve conduction study showed evidence of polyradiculopathies MESHD with dominant demyelination MESHD supporting the diagnosis of Guillain-Barre syndrome MESHD. The patients died after seven days; because of progressive respiratory failure HP respiratory failure MESHD.

    Development and Validation of a Web-Based Severe COVID-19 Risk Prediction Model

    Authors: Sang Hoon Woo; Arturo J. Rios-Diaz; Alan A. Kubey; Dianna R. Cheney-Peters; Lily L. Ackermann; Divya M. Chalikonda; Chantel M. Venkataraman; Joshua M. Riley; Michael Baram

    doi:10.1101/2020.07.16.20155739 Date: 2020-07-18 Source: medRxiv

    Background: Coronavirus disease MESHD 2019 (COVID-19) carries high morbidity and mortality globally. Identification of patients at risk for clinical deterioration upon presentation would aid in triaging, prognostication, and allocation of resources and experimental treatments. Research Question: Can we develop and validate a web-based risk prediction model for identification of patients who may develop severe COVID-19, defined as intensive care unit (ICU) admission, mechanical ventilation, and/or death? Methods: This retrospective cohort study reviewed 415 patients admitted to a large urban academic medical center and community hospitals. Covariates included demographic, clinical, and laboratory data. The independent association of predictors with severe COVID-19 was determined using multivariable logistic regression. A derivation cohort (n=311, 75%) was used to develop the prediction models. The models were tested by a validation cohort (n=104, 25%). Results: The median age TRANS was 66 years (Interquartile range [IQR] 54-77) and the majority were male TRANS (55%) and non-White (65.8%). The 14-day severe COVID-19 rate was 39.3%; 31.7% required ICU, 24.6% mechanical ventilation, and 21.2% died. Machine learning algorithms MESHD and clinical judgment were used to improve model performance SERO and clinical utility, resulting in the selection of eight predictors: age TRANS, sex, dyspnea HP dyspnea MESHD, diabetes mellitus HP diabetes mellitus MESHD, troponin, C-reactive protein, D-dimer, and aspartate aminotransferase. The discriminative ability was excellent for both the severe COVID-19 (training area under the curve [AUC]=0.82, validation AUC=0.82) and mortality (training AUC= 0.85, validation AUC=0.81) models. These models were incorporated into a mobile-friendly website. Interpretation: This web-based risk prediction model can be used at the bedside for prediction of severe COVID-19 using data mostly available at the time of presentation.

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MeSH Disease
Human Phenotype

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