Development and validation of a prognostic 40-day mortality risk model among hospitalized patients with COVID-19.
<h4>Objectives</h4>The development of a prognostic mortality risk model for hospitalized COVID-19 patients may facilitate patient treatment planning, comparisons of therapeutic strategies, and public health preparations.<h4>Methods</h4>We retrospectively reviewed the electron...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2021-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0255228 |
| _version_ | 1818743106980282368 |
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| author | Donald A Berry Andrew Ip Brett E Lewis Scott M Berry Nicholas S Berry Mary MrKulic Virginia Gadalla Burcu Sat Kristen Wright Michelle Serna Rashmi Unawane Katerina Trpeski Michael Koropsak Puneet Kaur Zachary Sica Andrew McConnell Urszula Bednarz Michael Marafelias Andre H Goy Andrew L Pecora Ihor S Sawczuk Stuart L Goldberg |
| author_facet | Donald A Berry Andrew Ip Brett E Lewis Scott M Berry Nicholas S Berry Mary MrKulic Virginia Gadalla Burcu Sat Kristen Wright Michelle Serna Rashmi Unawane Katerina Trpeski Michael Koropsak Puneet Kaur Zachary Sica Andrew McConnell Urszula Bednarz Michael Marafelias Andre H Goy Andrew L Pecora Ihor S Sawczuk Stuart L Goldberg |
| author_sort | Donald A Berry |
| collection | DOAJ |
| description | <h4>Objectives</h4>The development of a prognostic mortality risk model for hospitalized COVID-19 patients may facilitate patient treatment planning, comparisons of therapeutic strategies, and public health preparations.<h4>Methods</h4>We retrospectively reviewed the electronic health records of patients hospitalized within a 13-hospital New Jersey USA network between March 1, 2020 and April 22, 2020 with positive polymerase chain reaction results for SARS-CoV-2, with follow-up through May 29, 2020. With death or hospital discharge by day 40 as the primary endpoint, we used univariate followed by stepwise multivariate proportional hazard models to develop a risk score on one-half the data set, validated on the remainder, and converted the risk score into a patient-level predictive probability of 40-day mortality based on the combined dataset.<h4>Results</h4>The study population consisted of 3123 hospitalized COVID-19 patients; median age 63 years; 60% were men; 42% had >3 coexisting conditions. 713 (23%) patients died within 40 days of hospitalization for COVID-19. From 22 potential candidate factors 6 were found to be independent predictors of mortality and were included in the risk score model: age, respiratory rate ≥25/minute upon hospital presentation, oxygenation <94% on hospital presentation, and pre-hospital comorbidities of hypertension, coronary artery disease, or chronic renal disease. The risk score was highly prognostic of mortality in a training set and confirmatory set yielding in the combined dataset a hazard ratio of 1.80 (95% CI, 1.72, 1.87) for one unit increases. Using observed mortality within 20 equally sized bins of risk scores, a predictive model for an individual's 40-day risk of mortality was generated as -14.258 + 13.460*RS + 1.585*(RS-2.524)^2-0.403*(RS-2.524)^3. An online calculator of this 40-day COVID-19 mortality risk score is available at www.HackensackMeridianHealth.org/CovidRS.<h4>Conclusions</h4>A risk score using six variables is able to prognosticate mortality within 40-days of hospitalization for COVID-19.<h4>Trial registration</h4>Clinicaltrials.gov Identifier: NCT04347993. |
| first_indexed | 2024-12-18T02:23:09Z |
| format | Article |
| id | doaj.art-0544c34f8de74d10831452a6e428d4c2 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-18T02:23:09Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-0544c34f8de74d10831452a6e428d4c22022-12-21T21:24:05ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01167e025522810.1371/journal.pone.0255228Development and validation of a prognostic 40-day mortality risk model among hospitalized patients with COVID-19.Donald A BerryAndrew IpBrett E LewisScott M BerryNicholas S BerryMary MrKulicVirginia GadallaBurcu SatKristen WrightMichelle SernaRashmi UnawaneKaterina TrpeskiMichael KoropsakPuneet KaurZachary SicaAndrew McConnellUrszula BednarzMichael MarafeliasAndre H GoyAndrew L PecoraIhor S SawczukStuart L Goldberg<h4>Objectives</h4>The development of a prognostic mortality risk model for hospitalized COVID-19 patients may facilitate patient treatment planning, comparisons of therapeutic strategies, and public health preparations.<h4>Methods</h4>We retrospectively reviewed the electronic health records of patients hospitalized within a 13-hospital New Jersey USA network between March 1, 2020 and April 22, 2020 with positive polymerase chain reaction results for SARS-CoV-2, with follow-up through May 29, 2020. With death or hospital discharge by day 40 as the primary endpoint, we used univariate followed by stepwise multivariate proportional hazard models to develop a risk score on one-half the data set, validated on the remainder, and converted the risk score into a patient-level predictive probability of 40-day mortality based on the combined dataset.<h4>Results</h4>The study population consisted of 3123 hospitalized COVID-19 patients; median age 63 years; 60% were men; 42% had >3 coexisting conditions. 713 (23%) patients died within 40 days of hospitalization for COVID-19. From 22 potential candidate factors 6 were found to be independent predictors of mortality and were included in the risk score model: age, respiratory rate ≥25/minute upon hospital presentation, oxygenation <94% on hospital presentation, and pre-hospital comorbidities of hypertension, coronary artery disease, or chronic renal disease. The risk score was highly prognostic of mortality in a training set and confirmatory set yielding in the combined dataset a hazard ratio of 1.80 (95% CI, 1.72, 1.87) for one unit increases. Using observed mortality within 20 equally sized bins of risk scores, a predictive model for an individual's 40-day risk of mortality was generated as -14.258 + 13.460*RS + 1.585*(RS-2.524)^2-0.403*(RS-2.524)^3. An online calculator of this 40-day COVID-19 mortality risk score is available at www.HackensackMeridianHealth.org/CovidRS.<h4>Conclusions</h4>A risk score using six variables is able to prognosticate mortality within 40-days of hospitalization for COVID-19.<h4>Trial registration</h4>Clinicaltrials.gov Identifier: NCT04347993.https://doi.org/10.1371/journal.pone.0255228 |
| spellingShingle | Donald A Berry Andrew Ip Brett E Lewis Scott M Berry Nicholas S Berry Mary MrKulic Virginia Gadalla Burcu Sat Kristen Wright Michelle Serna Rashmi Unawane Katerina Trpeski Michael Koropsak Puneet Kaur Zachary Sica Andrew McConnell Urszula Bednarz Michael Marafelias Andre H Goy Andrew L Pecora Ihor S Sawczuk Stuart L Goldberg Development and validation of a prognostic 40-day mortality risk model among hospitalized patients with COVID-19. PLoS ONE |
| title | Development and validation of a prognostic 40-day mortality risk model among hospitalized patients with COVID-19. |
| title_full | Development and validation of a prognostic 40-day mortality risk model among hospitalized patients with COVID-19. |
| title_fullStr | Development and validation of a prognostic 40-day mortality risk model among hospitalized patients with COVID-19. |
| title_full_unstemmed | Development and validation of a prognostic 40-day mortality risk model among hospitalized patients with COVID-19. |
| title_short | Development and validation of a prognostic 40-day mortality risk model among hospitalized patients with COVID-19. |
| title_sort | development and validation of a prognostic 40 day mortality risk model among hospitalized patients with covid 19 |
| url | https://doi.org/10.1371/journal.pone.0255228 |
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