A Novel Scoring System for Early Assessment of the Risk of the COVID-19-associated Mortality in Hospitalized Patients: COVID-19 BURDEN

  1. Fatemeh Amirzadehfard
  2. Mohammad Hossein Imanieh
  3. Sina Zoghi
  4. Faezeh Sehatpour
  5. Peyman Jafari
  6. Hamidreza Hassanipour
  7. Maryam Feili
  8. Maryam Mollaie
  9. Pardis Bostanian
  10. Samrad Mehrabi
  11. Reyhaneh Dashtianeh
  12. Afrooz Feili

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Abstract

Background

Corona Virus Disease 2019 (COVID-19) presentation resembles common flu or can be more severe; it can result in hospitalization with significant morbidity and/or mortality. We made an attempt to develop a predictive model and a scoring system to improve the diagnostic efficiency for COVID-19 mortality via analysis of clinical features and laboratory data on admission.

Methods

We retrospectively enrolled 480 consecutive adult patients, aged 21-95, who were admitted to Faghihi Teaching Hospital. Clinical and laboratory features were extracted from the medical records and analyzed using multiple logistic regression analysis.

Results

A novel mortality risk score (COVID-19 BURDEN) was calculated, incorporating risk factors from this cohort. CRP (> 73.1 mg/L), O2 saturation variation (greater than 90%, 84-90%, and less than 84%), increased PT (>16.2s), diastolic blood pressure (≤75 mmHg), BUN (>23 mg/dL), and raised LDH (>731 U/L) are the features comprising the scoring system. The patients are triaged to the groups of low- (score <4) and high-risk (score ≥ 4) groups. The area under the curve, sensitivity, and specificity for predicting non-response to medical therapy with scores of ≥ 4 were 0.831, 78.12%, and 70.95%, respectively.

Conclusion

Using this scoring system in COVID-19 patients, the severity of the disease will be determined in the early stages of the disease, which will help to reduce hospital care costs and improve its quality and outcome.

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    SciScore for 10.1101/2022.01.09.22268975: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: The patients who did not complete their course of hospitalization and were released with their consent were excluded.
    IRB: The study protocol was approved by the local ethics committee of Shiraz University of Medical Sciences (IR.SUMS.MED.REC.1400.382).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    SPSS version 23 (SPSS Inc, IBM
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    M, New York, NY) and MedCalc statistical program, version 19.5 (MedCalc Software, Mariakerke, Belgium) were used to analyze the data.
    MedCalc
    suggested: (MedCalc, RRID:SCR_015044)

    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: We detected the following sentences addressing limitations in the study:
    This limitation is especially pronounced in ICUs for patients requiring mechanical ventilation (17). It is necessary to develop a scoring system that can be used by physicians, to estimate the severity of the disease and prognosis of each patient at an early stage of the disease, which will grant a wider timespan for interventions. This tool also helps to reduce hospital care costs and improves its quality in the health care units (18-20). In this survey, we designed a simplly calculated clinical risk score, by using the patient’s clinical characteristics and laboratory data, which can be used as a predictor to estimate the severity of the disease, the need for hospitalization, and the possibility of ICU admission requirement during hospitalization. Low DBP (≤ 75 mmHg), prolonged PT (> 16.2s), increase in the level of LDH (> 731 U/L), BUN >23mg/dl, elevated CRP (> 73.1 mg/L), and decrease in oxygen saturation (<84%) were detected as risk factors for disease severity among 480 adult patients. Using this scoring system is a useful strategy for screening high-risk patients in crowded care centers during the COVID-19 outbreak. Severe hypoxemia (O2 sat<84%) had the highest odds ratio (OR= 9.19) among the 6 risk factors determining the severity of the disease in our survey. This finding was consistent with a cohort study by Bahl et al. among 1461 patients in which O2 sat of ≤188% was associated with a higher mortality rate (21). In the review conducted by Petrilli et al. among 4103...

    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.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2022.01.09.22268975v1 on medRxiv