Clinical risk score to predict in-hospital mortality in COVID-19 patients: a retrospective cohort study
Objectives Several physiological abnormalities that develop during COVID-19 are associated with increased mortality. In the present study, we aimed to develop a clinical risk score to predict the in-hospital mortality in COVID-19 patients, based on a set of variables available soon after the hospita...
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e040729.full |
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| author | Adriano Peris Andrea Ungar Niccolò Marchionni Federico Lavorini Alessandro Bartoloni Stefano Fumagalli Rossella Marcucci Giulia Cesaroni Riccardo Pini Carlo Nozzoli Carlo Fumagalli Renzo Rozzini Matteo Vannini Flaminia Coccia Francesca Mazzeo Maria Cola Paolo Fontanari Alessandro Morettini Filippo Pieralli Loredana Poggesi |
| author_facet | Adriano Peris Andrea Ungar Niccolò Marchionni Federico Lavorini Alessandro Bartoloni Stefano Fumagalli Rossella Marcucci Giulia Cesaroni Riccardo Pini Carlo Nozzoli Carlo Fumagalli Renzo Rozzini Matteo Vannini Flaminia Coccia Francesca Mazzeo Maria Cola Paolo Fontanari Alessandro Morettini Filippo Pieralli Loredana Poggesi |
| author_sort | Adriano Peris |
| collection | DOAJ |
| description | Objectives Several physiological abnormalities that develop during COVID-19 are associated with increased mortality. In the present study, we aimed to develop a clinical risk score to predict the in-hospital mortality in COVID-19 patients, based on a set of variables available soon after the hospitalisation triage.Setting Retrospective cohort study of 516 patients consecutively admitted for COVID-19 to two Italian tertiary hospitals located in Northern and Central Italy were collected from 22 February 2020 (date of first admission) to 10 April 2020.Participants Consecutive patients≥18 years admitted for COVID-19.Main outcome measures Simple clinical and laboratory findings readily available after triage were compared by patients’ survival status (‘dead’ vs ‘alive’), with the objective of identifying baseline variables associated with mortality. These were used to build a COVID-19 in-hospital mortality risk score (COVID-19MRS).Results Mean age was 67±13 years (mean±SD), and 66.9% were male. Using Cox regression analysis, tertiles of increasing age (≥75, upper vs <62 years, lower: HR 7.92; p<0.001) and number of chronic diseases (≥4 vs 0–1: HR 2.09; p=0.007), respiratory rate (HR 1.04 per unit increase; p=0.001), PaO2/FiO2 (HR 0.995 per unit increase; p<0.001), serum creatinine (HR 1.34 per unit increase; p<0.001) and platelet count (HR 0.995 per unit increase; p=0.001) were predictors of mortality. All six predictors were used to build the COVID-19MRS (Area Under the Curve 0.90, 95% CI 0.87 to 0.93), which proved to be highly accurate in stratifying patients at low, intermediate and high risk of in-hospital death (p<0.001).Conclusions The COVID-19MRS is a rapid, operator-independent and inexpensive clinical tool that objectively predicts mortality in patients with COVID-19. The score could be helpful from triage to guide earlier assignment of COVID-19 patients to the most appropriate level of care. |
| format | Article |
| id | doaj-art-b994679ab4194473bd763b1815f9c032 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-b994679ab4194473bd763b1815f9c0322025-01-06T13:50:08ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2020-040729Clinical risk score to predict in-hospital mortality in COVID-19 patients: a retrospective cohort studyAdriano Peris0Andrea Ungar1Niccolò Marchionni2Federico Lavorini3Alessandro Bartoloni4Stefano Fumagalli5Rossella Marcucci6Giulia Cesaroni7Riccardo Pini8Carlo Nozzoli9Carlo Fumagalli10Renzo Rozzini11Matteo Vannini12Flaminia Coccia13Francesca Mazzeo14Maria Cola15Paolo Fontanari16Alessandro Morettini17Filippo Pieralli18Loredana Poggesi19Osped Univ Careggi, Florence, ItalyResearch Unit of Medicine of Aging, Department of Clinical and Experimental Medicine, University of Florence, Firenze, ItalyResearch Unit of Medicine of Aging, Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy3 Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy5 Department of Experimental and Clinical Medicine, University Hospital Careggi, Firenze, Toscana, ItalyDepartment of Experimental and Clinical Medicine, University of Florence, Florence, ItalyDepartment of Experimental and Clinical Medicine, University of Florence, Florence, ItalyDepartment of Epidemiology-Regional Health Service, ASL Roma 1, Rome, ItalyDepartment of Experimental and Clinical Medicine, University of Florence, Florence, ItalyDepartment of Internal and Emergency Medicine, Careggi Hospital, Florence, ItalyDepartment of Experimental and Clinical Medicine, University of Florence, Florence, ItalyDepartment of Internal Medicine and Geriatrics, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Lombardy, ItalyDepartment of Cardiothoracovascular Medicine, Careggi Hospital, Florence, ItalyDepartment of Internal Medicine and Geriatrics, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Lombardy, ItalyDepartment of Internal Medicine and Geriatrics, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Lombardy, ItalyDepartment of Internal and Emergency Medicine, Careggi Hospital, Florence, ItalyDepartment of Cardiothoracovascular Medicine, Careggi Hospital, Florence, ItalyDepartment of Internal and Emergency Medicine, Careggi Hospital, Florence, ItalyDepartment of Internal and Emergency Medicine, Careggi Hospital, Florence, ItalyDepartment of Experimental and Clinical Medicine, University of Florence, Florence, ItalyObjectives Several physiological abnormalities that develop during COVID-19 are associated with increased mortality. In the present study, we aimed to develop a clinical risk score to predict the in-hospital mortality in COVID-19 patients, based on a set of variables available soon after the hospitalisation triage.Setting Retrospective cohort study of 516 patients consecutively admitted for COVID-19 to two Italian tertiary hospitals located in Northern and Central Italy were collected from 22 February 2020 (date of first admission) to 10 April 2020.Participants Consecutive patients≥18 years admitted for COVID-19.Main outcome measures Simple clinical and laboratory findings readily available after triage were compared by patients’ survival status (‘dead’ vs ‘alive’), with the objective of identifying baseline variables associated with mortality. These were used to build a COVID-19 in-hospital mortality risk score (COVID-19MRS).Results Mean age was 67±13 years (mean±SD), and 66.9% were male. Using Cox regression analysis, tertiles of increasing age (≥75, upper vs <62 years, lower: HR 7.92; p<0.001) and number of chronic diseases (≥4 vs 0–1: HR 2.09; p=0.007), respiratory rate (HR 1.04 per unit increase; p=0.001), PaO2/FiO2 (HR 0.995 per unit increase; p<0.001), serum creatinine (HR 1.34 per unit increase; p<0.001) and platelet count (HR 0.995 per unit increase; p=0.001) were predictors of mortality. All six predictors were used to build the COVID-19MRS (Area Under the Curve 0.90, 95% CI 0.87 to 0.93), which proved to be highly accurate in stratifying patients at low, intermediate and high risk of in-hospital death (p<0.001).Conclusions The COVID-19MRS is a rapid, operator-independent and inexpensive clinical tool that objectively predicts mortality in patients with COVID-19. The score could be helpful from triage to guide earlier assignment of COVID-19 patients to the most appropriate level of care.https://bmjopen.bmj.com/content/10/9/e040729.full |
| spellingShingle | Adriano Peris Andrea Ungar Niccolò Marchionni Federico Lavorini Alessandro Bartoloni Stefano Fumagalli Rossella Marcucci Giulia Cesaroni Riccardo Pini Carlo Nozzoli Carlo Fumagalli Renzo Rozzini Matteo Vannini Flaminia Coccia Francesca Mazzeo Maria Cola Paolo Fontanari Alessandro Morettini Filippo Pieralli Loredana Poggesi Clinical risk score to predict in-hospital mortality in COVID-19 patients: a retrospective cohort study BMJ Open |
| title | Clinical risk score to predict in-hospital mortality in COVID-19 patients: a retrospective cohort study |
| title_full | Clinical risk score to predict in-hospital mortality in COVID-19 patients: a retrospective cohort study |
| title_fullStr | Clinical risk score to predict in-hospital mortality in COVID-19 patients: a retrospective cohort study |
| title_full_unstemmed | Clinical risk score to predict in-hospital mortality in COVID-19 patients: a retrospective cohort study |
| title_short | Clinical risk score to predict in-hospital mortality in COVID-19 patients: a retrospective cohort study |
| title_sort | clinical risk score to predict in hospital mortality in covid 19 patients a retrospective cohort study |
| url | https://bmjopen.bmj.com/content/10/9/e040729.full |
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