Early detection of severe COVID-19 disease patterns define near real-time personalised care, bioseverity in males, and decelerating mortality rates
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Abstract
Background
COVID-19 is a global health emergency. Recent data indicate a 50% mortality rate across UK intensive care units.
Methods
A single institution, two-centre retrospective analysis following implementation of a Decision Support tool and real-time data dashboard for early detection of patients requiring personalised enhanced care, focussing on respiratory rate, diastolic blood pressure, oxygenation indices, C-reactive protein, D-dimer and ferritin. Protocols differing from conventional practice included high-dose prophylactic anticoagulation for all COVID-19 positive patients and prescription of antioxidants.
Results
By 22/04/2020, 923 patients tested COVID-19 positive. 569 patients (61.7%) were male. The majority presented with advanced disease: interquartile ranges were C-reactive protein 44.9-179mg/L, D-dimer 1070-3802ng/mL, and ferritin 261-1208µg/L. Completed case fatality rates were 25.1% [95% CI 20.0, 30.0] in females, 40.5% [95% CI 35.9, 45.0] in males. 139 patients were admitted to intensive care where current death rates are 16.2% [95% CI 3.8, 28.7] in females, 38.2% [95% CI 28.6, 47.8] in males with no trends for differences based on ethnicity. A real-time traffic lights dashboard enabled rapid assessment of patients using critical parameters to accelerate adjustments to management protocols. In total 513 (55.6%) of patients were flagged as high risk for thromboembolic disease, exceeding the numbers flagged for respiratory deteriorations (N=391, 42.4%), or cytokine storm (N=68, 7.4%). There was minimal evidence that age was associated with disease severity, but males had higher levels of all dashboard indices, particularly C-reactive protein and ferritin (p<0.0001) which displayed no relationship with age.
Conclusions
Survival rates are encouraging. Protocols employed (traffic light-driven personalised care, protocolised early therapeutic anticoagulation based on D-dimer >1,000ng/mL and/or CRP>200 mg/L, personalised ventilatory strategies and antioxidants) are recommended to other units. Males are at greater risk of severe disease, most likely as the obligate SARS-CoV-2 receptor is encoded by the X-chromosome, and require especially close, and early attention.
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SciScore for 10.1101/2020.05.08.20088393: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable This had mapped largely non-overlapping datasets of 213,158 exomes and genomes from 111,454 males and 101,704 females to human genome builds GRCh37/hg19 [10] (version 2) and GRCh37/hg19 [11] Table 2: Resources
Software and Algorithms Sentences Resources Statistical analyses were performed in Stata IC version 15 (Statacorp, Texas) to generate descriptive statistics, graphical illustrations, to compare datasets, and to perform logistic and linear multiple regression. Statacorpsuggested: NoneSelected data were also illustrated using Microsoft Excel, … SciScore for 10.1101/2020.05.08.20088393: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable This had mapped largely non-overlapping datasets of 213,158 exomes and genomes from 111,454 males and 101,704 females to human genome builds GRCh37/hg19 [10] (version 2) and GRCh37/hg19 [11] Table 2: Resources
Software and Algorithms Sentences Resources Statistical analyses were performed in Stata IC version 15 (Statacorp, Texas) to generate descriptive statistics, graphical illustrations, to compare datasets, and to perform logistic and linear multiple regression. Statacorpsuggested: NoneSelected data were also illustrated using Microsoft Excel, Microsoft Powerpoint, and GraphPad Prism 8.1.1 for Windows, GraphPad Software, San Diego, California USA, www. graphpad.com. Microsoft Excelsuggested: (Microsoft Excel, RRID:SCR_016137)GraphPad Prismsuggested: (GraphPad Prism, RRID:SCR_002798)GraphPadsuggested: (GraphPad Prism, RRID:SCR_002798)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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