Development and validation of a predictive model of in-hospital mortality in COVID-19 patients

Abstract

We retrospectively evaluated 2879 hospitalized COVID-19 patients from four hospitals to evaluate the ability of demographic data, medical history, and on-admission laboratory parameters to predict in-hospital mortality. Association of previously published risk factors (age, gender, arterial hypertension, diabetes mellitus, smoking habit, obesity, renal failure, cardiovascular/ pulmonary diseases, serum ferritin, lymphocyte count, APTT, PT, fibrinogen, D-dimer, and platelet count) with death was tested by a multivariate logistic regression, and a predictive model was created, with further validation in an independent sample. A total of 2070 hospitalized COVID-19 patients were finally included in the multivariable analysis. Age 61–70 years (p<0.001; OR: 7.69; 95%CI: 2.93 to 20.14), age 71–80 years (p<0.001; OR: 14.99; 95%CI: 5.88 to 38.22), age >80 years (p<0.001; OR: 36.78; 95%CI: 14.42 to 93.85), male gender (p<0.001; OR: 1.84; 95%CI: 1.31 to 2.58), D-dimer levels >2 ULN (p = 0.003; OR: 1.79; 95%CI: 1.22 to 2.62), and prolonged PT (p<0.001; OR: 2.18; 95%CI: 1.49 to 3.18) were independently associated with increased in-hospital mortality. A predictive model performed with these parameters showed an AUC of 0.81 in the development cohort (n = 1270) [sensitivity of 95.83%, specificity of 41.46%, negative predictive value of 98.01%, and positive predictive value of 24.85%]. These results were then validated in an independent data sample (n = 800). Our predictive model of in-hospital mortality of COVID-19 patients has been developed, calibrated and validated. The model (MRS-COVID) included age, male gender, and on-admission coagulopathy markers as positively correlated factors with fatal outcome.

Epidemiologic and Genomic Analysis of the Severe Acute Respiratory Syndrome Coronavirus 2 Epidemic in the Nebraska Region of the United States, March 2020–2021

“…Overall, our study demonstrates that mortality risk among COVID-19 positive patients is influenced by a combination of age, sex, and the presence of specific comorbidities. These findings are supported by previous reports that show males over the age of 65 years with comorbidities like diabetes are at a greater risk of severe disease and mortality ( Hui et al, 2020 ; Williamson et al, 2020 ; Zheng et al, 2020 ; Zhou et al, 2020 ; Zhang et al, 2020a , b ; Betti et al, 2021 ; Velasco-Rodriguez et al, 2021 ). To this point, only 22.3% of our patient sample was over the age of 65 years, but this population accounted for 84.8% of the overall deaths and was disproportionately male.…”

Relationship Between Platelet Count and In-hospital Mortality in Adult Patients With COVID-19: A Retrospective Cohort Study

“…The original data of this study were from the development and validation of a predictive model of in-hospital mortality in COVID-19 patients study ( 14 ). Since Diego et al have relinquished the ownership of the original dataset to PLoS ONE ( https://journals.plos.org/plosone/s/data-availability ), we can use this dataset to perform secondary analysis based on different scientific hypotheses.…”

“…Since Diego et al have relinquished the ownership of the original dataset to PLoS ONE ( https://journals.plos.org/plosone/s/data-availability ), we can use this dataset to perform secondary analysis based on different scientific hypotheses. The original study was granted an exempt status and the requirement for obtaining informed consent was waived by the Ethics Committee for Clinical Research of the Hospital Universitario Fundación Jiménez Díaz ( 14 ). We followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines to report this study ( 15 ).…”

“…Baseline platelet count was first collected either in the emergency department or within 3 days from admission to a ward from electronic medical records ( 14 ).…”

“…In the general ( 10 ), COPD ( 11 ), venous thromboembolism ( 12 ), and elderly ( 13 ) populations, a U-shaped association was recognized between platelet count and mortality, though its role in COVID-19 remains unclear. Using data from the study of development and validation of a predictive model of in-hospital mortality in COVID-19 patients ( 14 ), a respective cohort study enriched for the presence of comorbidity and containing adjudicated events, we investigated post-hoc the association of platelet count measured at basement with in-hospital mortality.…”