Prediction of intensive care admission and hospital mortality in COVID-19 patients using demographics and baseline laboratory data

Abstract

Introduction:  Optimized allocation of medical resources to patients with COVID-19 has been a critical concern since the onset of the pandemic.

Methods:  In this retrospective cohort study, the authors used data from a Brazilian tertiary university hospital to explore predictors of Intensive Care Unit (ICU) admission and hospital mortality in patients admitted for COVID-19. Our primary aim was to create and validate prediction scores for use in hospitals and emergency departments to aid clinical decisions and resource allocation.

Results:  The study cohort included 3,022 participants, of whom 2,485 were admitted to the ICU; 1968 survived, and 1054 died in the hospital. From the complete cohort, 1,496 patients were randomly assigned to the derivation sample and 1,526 to the validation sample. The final scores included age, comorbidities, and baseline laboratory data. The areas under the receiver operating characteristic curves were very similar for the derivation and validation samples. Scores for ICU admission had a 75% accuracy in the validation sample, whereas scores for death had a 77% accuracy in the validation sample. The authors found that including baseline flu-like symptoms in the scores added no significant benefit to their accuracy. Furthermore, our scores were more accurate than the previously published NEWS-2 and 4C Mortality Scores.

Discussion and conclusions:  The authors developed and validated prognostic scores that use readily available clinical and laboratory information to predict ICU admission and mortality in COVID-19. These scores can become valuable tools to support clinical decisions and improve the allocation of limited health resources.

Keywords: COVID-19; SARS-CoV-2; Critical Care; Mortality; Intensive Care; Risk Score; Prediction

HIGHLIGHTS

Prediction scores can be used to support clinical decisions and resource allocation.

The authors used data from 3,022 hospitalized patients with COVID-19, of whom 1054 died.

The final scores included age, comorbidities, and baseline laboratory data.

Accuracy was 75% for ICU admission and 77% for death in the validation sample.

Our scores were more accurate than the previous NEWS-2 and 4C Mortality Scores.