COVID-19 risk index (CRI): a simple and validated emergency department risk score that predicts mortality and the need for mechanical ventilation

Abstract

Although certain risk factors have been associated with morbidity and mortality, validated emergency department (ED) derived risk prediction models specific to coronavirus disease 2019 (COVID-19) are lacking. The objective of this study is to describe and externally validate the COVID-19 risk index (CRI). A large retrospective longitudinal cohort study was performed to analyze consecutively hospitalized patients with COVID-19. Multivariate regression using clinical data elements from the ED was used to create the CRI. The results were validated with an external cohort of 1799 patients from the MI-COVID19 database. The primary outcome was the composite of the need for mechanical ventilation or inpatient mortality, and the secondary outcome was inpatient mortality. A total of 1020 patients were included in the derivation cohort. A total of 236 (23%) patients in the derivation cohort required mechanical ventilation or died. Variables independently associated with the primary outcome were age ≥ 65 years, chronic obstructive pulmonary disease, chronic kidney disease, cerebrovascular disease, initial D-dimer > 1.1 µg/mL, platelet count < 150 K/µL, and severity of SpO2:FiO2 ratio. The derivation cohort had an area under the receiver operator characteristic curve (AUC) of 0.83, and 0.74 in the external validation cohort Calibration shows close adherence between the observed and expected primary outcomes within the validation cohort. The CRI is a novel disease-specific tool that assesses the risk for mechanical ventilation or death in hospitalized patients with COVID-19. Discrimination of the score may change given continuous updates in contemporary COVID-19 management and outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s11239-021-02565-6.

Preadmission Oral Anticoagulation for Atrial Fibrillation/Flutter and Death or Thrombotic Events During COVID-19 Admission

“…Patients on preadmission OAC had a higher prevalence of demographic and co-morbid characteristics associated with adverse outcomes during hospitalization for COVID-19. 14 , 15 Patients on preadmission OAC were older, more frequent tobacco users, more often Hispanic, and more likely to have a history of heart failure, myocardial infarction, TIA, stroke, DVT, PE, chronic kidney disease, and cancer, and were less likely to have a history of alcohol use disorder. These patients were also less likely to be taking aspirin or a P2Y 12 inhibitor, and more likely to be on a statin before admission when compared with those who were not taking OAC.…”

Comparison of static and rolling logistic regression models on predicting invasive mechanical ventilation or death from COVID‐19—A retrospective, multicentre study

“…SpO 2 , a measure of oxygenation, and S/F, appeared infrequently in the models, which differs from previous studies that found S/F to be highly associated with the need for IMV or death; however, these studies did not separately analyse FiO 2 . 11 , 19 , 20 , 21 A rising FiO 2 should be taken as one of the warning signs for impending death or need for IMV. Vital signs, particularly, respiratory rate and temperature, were also commonly present in the models.…”

Threshold of increase in oxygen demand to predict mechanical ventilation use in novel coronavirus disease 2019: A retrospective cohort study incorporating restricted cubic spline regression

“…While several studies have attempted to develop a prediction model for the need of MV or ICU admission, there is no well-accepted method that captures rapidly changing respiratory status in patients with COVID-19 [ 7 – 12 ]. Although some clinical scoring systems showed promising results with high discrimination, most use daily clinical data or those on admission and only predict deterioration within 24–48 h or thereafter [ 8 , 9 , 11 , 12 ]. Since candidates for MV are usually on oxygen therapy and changes in respiratory status are frequently assessed within a day, estimation with such a long-term interval using a score is not practical.…”