Can doctors predict mortality by COVID-19 at the emergency room?
Published: February 28, 2021
Coronavirus disease 2019 (COVID-19) is a highly variable condition, ranging from asymptomatic to fatal. Therefore, validated tools to assist in the early detection of patients at high risk of mortality can help guide medical decisions. In a research article recently published in The Journal of Allergy and Clinical Immunology (JACI), Utrero-Rico and his colleagues validate their previously published predictive model which provides a quantifiable risk of death in hospitalized COVID-19 patients.
Validation of the model was performed in two external cohorts with 185 and 730 COVID-19 patients from the first wave and one internal cohort with 119 COVID-19 patients from the second wave. The probability of death was calculated for all subjects using the predictive model, which includes five variables easily measured in the emergency room or soon after hospitalisation: age, interleukin-6, lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio and peripheral blood oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) ratio.
The mortality prediction model showed a good performance in the external and the second wave validation cohorts, which means it was able to identify high risk patients as early as at their arrival to the hospital. This external validation is important because it showed that, despite significant differences between the development and the validation cohorts, the prediction model still worked with high accuracy in the latter. Likewise, this validation in second wave patients is relevant given the epidemiological and clinical practice differences between the first and second wave of the pandemic, for example in the frequency of corticoid use.
Finally, in order to improve the predictive performance in any clinical setting, the predictive model was updated by re-estimating the weights of the five biomarkers in an overall cohort including all patients (1477 individuals) from the development and validation cohorts. The updated model was also useful to accurately predict fatal outcome, including in patients without shortness of breath at the time of evaluation.
This mortality prediction model has been thoroughly validated. It is freely available as the online calculator COR+12 (https://utrero-rico.shinyapps.io/COR12_Score/) to help clinicians and researchers to efficiently classify patients with COVID-19. Moreover, the model has been updated showing good discrimination. This suggests that the updated model is likely to be generalizable to other populations and clinical settings, and that its predictive performance should be accurate when applied to its target population, COVID-19 patients who are in the emergency room and require hospitalization, and COVID-19 patients who have recently been hospitalized.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.
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