TY - JOUR
T1 - A clinical risk score to predict in-hospital mortality in critically ill patients with COVID-19
T2 - A retrospective cohort study
AU - Alkaabi, Salem
AU - Alnuaimi, Asma
AU - Alharbi, Mariam
AU - Amari, Mohammed A.
AU - Ganapathy, Rajiv
AU - Iqbal, Imran
AU - Nauman, Javaid
AU - Oulhaj, Abderrahim
N1 - Funding Information:
The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/8/26
Y1 - 2021/8/26
N2 - Objectives To identify factors influencing the mortality risk in critically ill patients with COVID-19, and to develop a risk prediction score to be used at admission to intensive care unit (ICU). Design A multicentre cohort study. Setting and participants 1542 patients with COVID-19 admitted to ICUs in public hospitals of Abu Dhabi, United Arab Emirates between 1 March 2020 and 22 July 2020. Main outcomes and measures The primary outcome was time from ICU admission until death. We used competing risk regression models and Least Absolute Shrinkage and Selection Operator to identify the factors, and to construct a risk score. Predictive ability of the score was assessed by the area under the receiver operating characteristic curve (AUC), and the Brier score using 500 bootstraps replications. Results Among patients admitted to ICU, 196 (12.7%) died, 1215 (78.8%) were discharged and 131 (8.5%) were right-censored. The cumulative mortality incidence was 14% (95% CI 12.17% to 15.82%). From 36 potential predictors, we identified seven factors associated with mortality, and included in the risk score: age (adjusted HR (AHR) 1.98; 95% CI 1.71 to 2.31), neutrophil percentage (AHR 1.71; 95% CI 1.27 to 2.31), lactate dehydrogenase (AHR 1.31; 95% CI 1.15 to 1.49), respiratory rate (AHR 1.31; 95% CI 1.15 to 1.49), creatinine (AHR 1.19; 95% CI 1.11 to 1.28), Glasgow Coma Scale (AHR 0.70; 95% CI 0.63 to 0.78) and oxygen saturation (SpO 2) (AHR 0.82; 95% CI 0.74 to 0.91). The mean AUC was 88.1 (95% CI 85.6 to 91.6), and the Brier score was 8.11 (95% CI 6.74 to 9.60). We developed a freely available web-based risk calculator (https://icumortalityrisk.shinyapps.io/ICUrisk/). Conclusion In critically ill patients with COVID-19, we identified factors associated with mortality, and developed a risk prediction tool that showed high predictive ability. This tool may have utility in clinical settings to guide decision-making, and may facilitate the identification of supportive therapies to improve outcomes.
AB - Objectives To identify factors influencing the mortality risk in critically ill patients with COVID-19, and to develop a risk prediction score to be used at admission to intensive care unit (ICU). Design A multicentre cohort study. Setting and participants 1542 patients with COVID-19 admitted to ICUs in public hospitals of Abu Dhabi, United Arab Emirates between 1 March 2020 and 22 July 2020. Main outcomes and measures The primary outcome was time from ICU admission until death. We used competing risk regression models and Least Absolute Shrinkage and Selection Operator to identify the factors, and to construct a risk score. Predictive ability of the score was assessed by the area under the receiver operating characteristic curve (AUC), and the Brier score using 500 bootstraps replications. Results Among patients admitted to ICU, 196 (12.7%) died, 1215 (78.8%) were discharged and 131 (8.5%) were right-censored. The cumulative mortality incidence was 14% (95% CI 12.17% to 15.82%). From 36 potential predictors, we identified seven factors associated with mortality, and included in the risk score: age (adjusted HR (AHR) 1.98; 95% CI 1.71 to 2.31), neutrophil percentage (AHR 1.71; 95% CI 1.27 to 2.31), lactate dehydrogenase (AHR 1.31; 95% CI 1.15 to 1.49), respiratory rate (AHR 1.31; 95% CI 1.15 to 1.49), creatinine (AHR 1.19; 95% CI 1.11 to 1.28), Glasgow Coma Scale (AHR 0.70; 95% CI 0.63 to 0.78) and oxygen saturation (SpO 2) (AHR 0.82; 95% CI 0.74 to 0.91). The mean AUC was 88.1 (95% CI 85.6 to 91.6), and the Brier score was 8.11 (95% CI 6.74 to 9.60). We developed a freely available web-based risk calculator (https://icumortalityrisk.shinyapps.io/ICUrisk/). Conclusion In critically ill patients with COVID-19, we identified factors associated with mortality, and developed a risk prediction tool that showed high predictive ability. This tool may have utility in clinical settings to guide decision-making, and may facilitate the identification of supportive therapies to improve outcomes.
KW - COVID-19
KW - epidemiology
KW - intensive & critical care
KW - preventive medicine
KW - public health
UR - http://www.scopus.com/inward/record.url?scp=85113926327&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85113926327&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2021-048770
DO - 10.1136/bmjopen-2021-048770
M3 - Article
C2 - 34446489
AN - SCOPUS:85113926327
SN - 2044-6055
VL - 11
JO - BMJ Open
JF - BMJ Open
IS - 8
M1 - e048770
ER -