A Risk Score to Predict Admission to the Intensive Care Unit in Patients with COVID-19: the ABC-GOALS score

  1. Juan M Mejía-Vilet
  2. Bertha M. Córdova-Sánchez
  3. Dheni A. Fernández-Camargo
  4. R. Angélica Méndez-Pérez
  5. Luis E Morales-Buenrostro
  6. Thierry Hernández-Gilsoul

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Abstract

Objective. To develop a score to predict the need for ICU admission in COVID-19.Methods. We assessed patients admitted to a COVID-19 center in Mexico. Patients were segregated into a group that required ICU admission, and a group that never required ICU admission. By logistic regression, we derived predictive models including clinical, laboratory, and imaging findings. The ABC-GOALS was constructed and compared to other scores.Results. We included 329 and 240 patients in the development and validation cohorts, respectively. One-hundred-fifteen patients from each cohort required ICU admission. The clinical (ABC-GOALSc), clinical+laboratory (ABC-GOALScl), clinical+laboratory+image (ABC-GOALSclx) models area under the curve were 0.79 (95%CI=0.74-0.83) and 0.77 (95%CI=0.71-0.83), 0.86 (95%CI=0.82-0.90) and 0.87 (95%CI=0.83-0.92), 0.88 (95%CI=0.84-0.92) and 0.86 (95%CI=0.81-0.90), in the development and validation cohorts, respectively. The ABC-GOALScl and ABC-GOALSclx outperformed other COVID-19 and pneumonia predictive scores.Conclusion. ABC-GOALS is a tool to timely predict the need for admission to ICU in COVID-19.

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  1. Version published to 10.21149/11684
  2. ScreenIT

    SciScore for 10.1101/2020.05.12.20099416: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the local Research and Ethics Board (CAI-3368-20-20-1) that waived the use of a written informed consent form due to the study’s nature.
    Consent: The study was approved by the local Research and Ethics Board (CAI-3368-20-20-1) that waived the use of a written informed consent form due to the study’s nature.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed with SPSS version 24.0 (IBM, Armonk, NY, USA) and GraphPad Prism 6.0 (GraphPad Software, San Diego, CA, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    GraphPad
    suggested: (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: We detected the following sentences addressing limitations in the study:
    Third, the study is reported based on TRIPOD guidelines 37 There are limitations to this study. The study included a single-center and very sick population with high rates of ICU admission; therefore, the score may perform well in severe hospitalized patients with COVID-pneumonia. There is still a need for external validation. Another limitation is that medical practice and admission criteria to ICU may vary between institutions and countries, especially in stressed health systems. This score was derived from a population living in Mexico City at >7300 feet over the sea level. The mean partial pressure of oxygen at this altitude has been estimated at around 66mmHg (estimated normal baseline P/F ratio ≈ 314) 38,39. Therefore, we used the S/F ratio to account for respiratory compensation and the right-shift of the hemoglobin dissociation curve that takes place at higher altitudes. Finally, the thresholds set to define the low-, moderate- and high-risk groups should be adapted to local needs and ICU availability. Therefore, we provided the estimated percentages of ICU admission for each sum of the score. In summary, the ABC-GOALS score represents a tool to evaluate patients with COVID-19 at admission to the ED, designed to timely predict their risk of admission to an ICU. This score may help early referral and planning of attention during the COVID-19 pandemic.

    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.

    About SciScore

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  3. Version published to 10.1101/2020.05.12.20099416v2 on medRxiv
  4. Version published to 10.1101/2020.05.12.20099416v1 on medRxiv