Development and validation of a prediction model for severe respiratory failure in hospitalized patients with SARS-CoV-2 infection: a multicentre cohort study (PREDI-CO study)

Abstract

Objectives We aimed to develop and validate a risk score to predict severe respiratory failure (SRF) among patients hospitalized with coronavirus disease-2019 (COVID-19). Methods We performed a multicentre cohort study among hospitalized (>24 hours) patients diagnosed with COVID-19 from 22 February to 3 April 2020, at 11 Italian hospitals. Patients were divided into derivation and validation cohorts according to random sorting of hospitals. SRF was assessed from admission to hospital discharge and was defined as: Sp o 2 <93% with 100% Fi o 2 , respiratory rate >30 breaths/min or respiratory distress. Multivariable logistic regression models were built to identify predictors of SRF, β-coefficients were used to develop a risk score. Trial Registration NCT04316949 . Results We analysed 1113 patients (644 derivation, 469 validation cohort). Mean (±SD) age was 65.7 (±15) years, 704 (63.3%) were male. SRF occurred in 189/644 (29%) and 187/469 (40%) patients in the derivation and validation cohorts, respectively. At multivariate analysis, risk factors for SRF in the derivation cohort assessed at hospitalization were age ≥70 years (OR 2.74; 95% CI 1.66–4.50), obesity (OR 4.62; 95% CI 2.78–7.70), body temperature ≥38°C (OR 1.73; 95% CI 1.30–2.29), respiratory rate ≥22 breaths/min (OR 3.75; 95% CI 2.01–7.01), lymphocytes ≤900 cells/mm 3 (OR 2.69; 95% CI 1.60–4.51), creatinine ≥1 mg/dL (OR 2.38; 95% CI 1.59–3.56), C-reactive protein ≥10 mg/dL (OR 5.91; 95% CI 4.88–7.17) and lactate dehydrogenase ≥350 IU/L (OR 2.39; 95% CI 1.11–5.11). Assigning points to each variable, an individual risk score (PREDI-CO score) was obtained. Area under the receiver-operator curve was 0.89 (0.86–0.92). At a score of >3, sensitivity, specificity, and positive and negative predictive values were 71.6% (65%–79%), 89.1% (86%–92%), 74% (67%–80%) and 89% (85%–91%), respectively. PREDI-CO score showed similar prognostic ability in the validation cohort: area under the receiver-operator curve 0.85 (0.81–0.88). At a score of >3, sensitivity, specificity, and positive and negative predictive values were 80% (73%–85%), 76% (70%–81%), 69% (60%–74%) and 85% (80%–89%), respectively. Conclusion PREDI-CO score can be useful to allocate resources and prioritize treatments during the COVID-19 pandemic.

COVID-19 and COPD: a narrative review of the basic science and clinical outcomes

“…In the larger New York cohort (13 442 patients with COVID-19 attending the emergency department), COPD was associated with an increased risk of hospitalisation (RR 1.77, 95% CI 1.67-1.87) [100], and a trend for increased mortality (RR 1.08, 95% CI 0.88-1.33). Similar findings were reported in an Italian cohort involving 1044 hospitalised patients; patients with COPD had significantly increased risk of severe respiratory failure (RR 1.17, 95% CI 1.09-1.27) [102]. In a Spanish longitudinal cohort, COPD was also associated with a 70% increase in the risk of death (RR 1.69, 95% CI 1.23-2.32) [111].…”

“…Secondly, there is no clinical evidence that ICS are protective against COVID-19 or are associated with worse clinical outcomes [94]. Finally, whilst the available evidence from cohort studies does not demonstrate that COPD patients are more or less susceptible to acquiring infection with SARS-CoV-2, clinical outcomes including requirement for mechanical ventilation and mortality appear to be worse in COPD patients [102][103][104][105][106][107]111]. Support statement: This research was supported by the NIHR Manchester Biomedical Research Centre and the North West Lung Centre Charity, Manchester.…”

“…Prevalence % (95% CI) ALQAHTANI [98] ARGENZIANO [99] GUAN [100] MARCELLO [101] Hospitalised patients ARGENZIANO [99] BARTOLETTI [102] DOCHERTY [103] MARCELLO [101] PARANJPE [104] RICHARDSON [105] Critically ill patients ARGENZIANO [99] CUMMINGS [ Consistently, the prevalence of COPD rises further among patients suffering from more critical or lethal COVID-19 disease. A series of 257 critically ill patients admitted to the intensive care unit with COVID-19 in New York revealed a much higher prevalence of COPD (9%) and current or former smokers (33%) [106].…”

Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy

“…To our knowledge, the combined effect of CKD and AKI as risk factors for mortality in COVID-19 has been poorly explored so far and our findings might provide interesting prognostic predictors to be further evaluated in this setting. Several mortality risk scores have been proposed to predict mortality in COVID-19 patients [12,33,34], most of which did not include an evaluation of kidney status. In our study cohort, patients with CKD complicated by AKI showed a significantly higher risk of score mortality by Zhao et al ≥ 2 as compared to patients with only acute or chronic kidney involvement or without kidney damage, respectively (74.7 vs 53.8 vs 67.0 vs 32.5, χ 2 131.7, p < 0.0001).…”

D-dimer, Troponin, and Urea Level at Presentation With COVID-19 can Predict ICU Admission: A Single Centered Study

“…During the manuscript writing, a scoring system of COVID-19 (CSS) was suggested that could help clinicians to identify high-risk patients with poor prognosis ( 13 ). Another promising predictive tool PREDI-CO score was suggested to be useful in resource allocation and treatment prioritization during the COVID-19 pandemic ( 14 ). We aimed to identify differences in patients' demographic, clinical, laboratory, and radiological findings between mild, severe, and critical cases of COVID-19 positive cases to develop and validate a diagnostic model predicting who will develop severe form and who will need critical care throughout the course of the disease.…”