Scoring systems for predicting mortality for severe patients with COVID-19
Background: Coronavirus disease 2019 (COVID-19) has been widely spread and caused tens of thousands of deaths, especially in patients with severe COVID-19. This analysis aimed to explore risk factors for mortality of severe COVID-19, and establish a scoring system to predict in-hospital deaths. Meth...
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Format: | Article |
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Elsevier
2020-07-01
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Series: | EClinicalMedicine |
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Online Access: | http://www.sciencedirect.com/science/article/pii/S258953702030170X |
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doaj-f96fd86b40204bf18cd0545bff92cc17 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yufeng Shang Tao Liu Yongchang Wei Jingfeng Li Liang Shao Minghui Liu Yongxi Zhang Zhigang Zhao Haibo Xu Zhiyong Peng Fuling Zhou Xinghuan Wang |
spellingShingle |
Yufeng Shang Tao Liu Yongchang Wei Jingfeng Li Liang Shao Minghui Liu Yongxi Zhang Zhigang Zhao Haibo Xu Zhiyong Peng Fuling Zhou Xinghuan Wang Scoring systems for predicting mortality for severe patients with COVID-19 EClinicalMedicine COVID-19 Critical ill Scoring system Antibody Mortality |
author_facet |
Yufeng Shang Tao Liu Yongchang Wei Jingfeng Li Liang Shao Minghui Liu Yongxi Zhang Zhigang Zhao Haibo Xu Zhiyong Peng Fuling Zhou Xinghuan Wang |
author_sort |
Yufeng Shang |
title |
Scoring systems for predicting mortality for severe patients with COVID-19 |
title_short |
Scoring systems for predicting mortality for severe patients with COVID-19 |
title_full |
Scoring systems for predicting mortality for severe patients with COVID-19 |
title_fullStr |
Scoring systems for predicting mortality for severe patients with COVID-19 |
title_full_unstemmed |
Scoring systems for predicting mortality for severe patients with COVID-19 |
title_sort |
scoring systems for predicting mortality for severe patients with covid-19 |
publisher |
Elsevier |
series |
EClinicalMedicine |
issn |
2589-5370 |
publishDate |
2020-07-01 |
description |
Background: Coronavirus disease 2019 (COVID-19) has been widely spread and caused tens of thousands of deaths, especially in patients with severe COVID-19. This analysis aimed to explore risk factors for mortality of severe COVID-19, and establish a scoring system to predict in-hospital deaths. Methods: Patients with COVID-19 were retrospectively analyzed and clinical characteristics were compared. LASSO regression as well as multivariable analysis were used to screen variables and establish prediction model. Findings: A total of 2529 patients with COVID-19 was retrospectively analyzed, and 452 eligible severe COVID-19 were used for finally analysis. In training cohort, the median age was 66•0 years while it was 73•0 years in non-survivors. Patients aged 60–75 years accounted for the largest proportion of infected populations and mortality toll. Anti-SARS-CoV-2 antibodies were monitored up to 54 days, and IgG levels reached the highest during 20–30 days. No differences were observed of antibody levels between severe and non-severe patients. About 60.2% of severe patients had complications. Among acute myocardial injury (AMI), acute kidney injury (AKI) and acute liver injury (ALI), the heart was the earliest injured organ, whereas the time from AKI to death was the shortest. Age, diabetes, coronary heart disease (CHD), percentage of lymphocytes (LYM%), procalcitonin (PCT), serum urea, C reactive protein and D-dimer (DD), were identified associated with mortality by LASSO binary logistic regression. Then multivariable analysis was performed to conclude that old age, CHD, LYM%, PCT and DD remained independent risk factors for mortality. Based on the above variables, a scoring system of COVID-19 (CSS) was established to divide patients into low-risk and high-risk groups. This model displayed good discrimination (AUC=0·919) and calibration (P=0·264). Complications in low-risk and high-risk groups were significantly different (P<0·05). Use of corticosteroids in low-risk groups increased hospital stays by 4·5 days (P=0·036) and durations of disease by 7·5 days (P=0·012) compared with no corticosteroids. Interpretation: Old age, CHD, LYM%, PCT and DD were independently related to mortality. CSS was useful for predicting in-hospital mortality and complications, and it could help clinicians to identify high-risk patients with poor prognosis. Funding: This work was supported by the Key Project for Anti-2019 novel Coronavirus Pneumonia from the Ministry of Science and Technology, China (grant number 2020YFC0845500). |
topic |
COVID-19 Critical ill Scoring system Antibody Mortality |
url |
http://www.sciencedirect.com/science/article/pii/S258953702030170X |
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doaj-f96fd86b40204bf18cd0545bff92cc172020-11-25T03:15:27ZengElsevierEClinicalMedicine2589-53702020-07-0124100426Scoring systems for predicting mortality for severe patients with COVID-19Yufeng Shang0Tao Liu1Yongchang Wei2Jingfeng Li3Liang Shao4Minghui Liu5Yongxi Zhang6Zhigang Zhao7Haibo Xu8Zhiyong Peng9Fuling Zhou10Xinghuan Wang11Department of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, PR ChinaDepartment of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, PR ChinaDepartment of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR ChinaDepartment of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR ChinaDepartment of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, PR ChinaDepartment of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, PR ChinaDepartment of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR ChinaEmergency Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR ChinaDepartment of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR ChinaDepartment of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR ChinaDepartment of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, PR China; Corresponding author at: Department of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, PR China.Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, PR China; Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR China; Corresponding author.Background: Coronavirus disease 2019 (COVID-19) has been widely spread and caused tens of thousands of deaths, especially in patients with severe COVID-19. This analysis aimed to explore risk factors for mortality of severe COVID-19, and establish a scoring system to predict in-hospital deaths. Methods: Patients with COVID-19 were retrospectively analyzed and clinical characteristics were compared. LASSO regression as well as multivariable analysis were used to screen variables and establish prediction model. Findings: A total of 2529 patients with COVID-19 was retrospectively analyzed, and 452 eligible severe COVID-19 were used for finally analysis. In training cohort, the median age was 66•0 years while it was 73•0 years in non-survivors. Patients aged 60–75 years accounted for the largest proportion of infected populations and mortality toll. Anti-SARS-CoV-2 antibodies were monitored up to 54 days, and IgG levels reached the highest during 20–30 days. No differences were observed of antibody levels between severe and non-severe patients. About 60.2% of severe patients had complications. Among acute myocardial injury (AMI), acute kidney injury (AKI) and acute liver injury (ALI), the heart was the earliest injured organ, whereas the time from AKI to death was the shortest. Age, diabetes, coronary heart disease (CHD), percentage of lymphocytes (LYM%), procalcitonin (PCT), serum urea, C reactive protein and D-dimer (DD), were identified associated with mortality by LASSO binary logistic regression. Then multivariable analysis was performed to conclude that old age, CHD, LYM%, PCT and DD remained independent risk factors for mortality. Based on the above variables, a scoring system of COVID-19 (CSS) was established to divide patients into low-risk and high-risk groups. This model displayed good discrimination (AUC=0·919) and calibration (P=0·264). Complications in low-risk and high-risk groups were significantly different (P<0·05). Use of corticosteroids in low-risk groups increased hospital stays by 4·5 days (P=0·036) and durations of disease by 7·5 days (P=0·012) compared with no corticosteroids. Interpretation: Old age, CHD, LYM%, PCT and DD were independently related to mortality. CSS was useful for predicting in-hospital mortality and complications, and it could help clinicians to identify high-risk patients with poor prognosis. Funding: This work was supported by the Key Project for Anti-2019 novel Coronavirus Pneumonia from the Ministry of Science and Technology, China (grant number 2020YFC0845500).http://www.sciencedirect.com/science/article/pii/S258953702030170XCOVID-19Critical illScoring systemAntibodyMortality |