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A clinical risk score to identify patients with COVID-19 at high risk of critical care admission or death: An observational cohort study.
Galloway, James B; Norton, Sam; Barker, Richard D; Brookes, Andrew; Carey, Ivana; Clarke, Benjamin D; Jina, Raeesa; Reid, Carole; Russell, Mark D; Sneep, Ruth; Sugarman, Leah; Williams, Sarah; Yates, Mark; Teo, James; Shah, Ajay M; Cantle, Fleur.
  • Galloway JB; Centre for Rheumatic Disease, King's College London, London, United Kingdom. Electronic address: james.galloway@kcl.ac.uk.
  • Norton S; Centre for Rheumatic Disease, King's College London, London, United Kingdom.
  • Barker RD; Department of Respiratory Medicine, King's College Hospital, London, United Kingdom.
  • Brookes A; Department of Emergency Medicine, King's College Hospital, London, United Kingdom.
  • Carey I; Institute of Liver Studies, King's College Hospital, London, United Kingdom.
  • Clarke BD; Centre for Rheumatic Disease, King's College London, London, United Kingdom.
  • Jina R; Department of Emergency Medicine, King's College Hospital, London, United Kingdom.
  • Reid C; Department of Emergency Medicine, King's College Hospital, London, United Kingdom.
  • Russell MD; Centre for Rheumatic Disease, King's College London, London, United Kingdom.
  • Sneep R; Department of Emergency Medicine, King's College Hospital, London, United Kingdom.
  • Sugarman L; Department of Emergency Medicine, King's College Hospital, London, United Kingdom.
  • Williams S; Department of Emergency Medicine, King's College Hospital, London, United Kingdom.
  • Yates M; Centre for Rheumatic Disease, King's College London, London, United Kingdom.
  • Teo J; Department of Neurosciences, King's College Hospital, London, United Kingdom.
  • Shah AM; School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre, London, United Kingdom.
  • Cantle F; Department of Emergency Medicine, King's College Hospital, London, United Kingdom.
J Infect ; 81(2): 282-288, 2020 08.
Article in English | MEDLINE | ID: covidwho-436927
ABSTRACT

BACKGROUND:

The COVID-19 pandemic continues to escalate. There is urgent need to stratify patients. Understanding risk of deterioration will assist in admission and discharge decisions, and help selection for clinical studies to indicate where risk of therapy-related complications is justified.

METHODS:

An observational cohort of patients acutely admitted to two London hospitals with COVID-19 and positive SARS-CoV-2 swab results was assessed. Demographic details, clinical data, comorbidities, blood parameters and chest radiograph severity scores were collected from electronic health records. Endpoints assessed were critical care admission and death. A risk score was developed to predict outcomes.

FINDINGS:

Analyses included 1,157 patients. Older age, male sex, comorbidities, respiratory rate, oxygenation, radiographic severity, higher neutrophils, higher CRP and lower albumin at presentation predicted critical care admission and mortality. Non-white ethnicity predicted critical care admission but not death. Social deprivation was not predictive of outcome. A risk score was developed incorporating twelve characteristics age>40, male, non-white ethnicity, oxygen saturations<93%, radiological severity score>3, neutrophil count>8.0 x109/L, CRP>40 mg/L, albumin<34 g/L, creatinine>100 µmol/L, diabetes mellitus, hypertension and chronic lung disease. Risk scores of 4 or higher corresponded to a 28-day cumulative incidence of critical care admission or death of 40.7% (95% CI 37.1 to 44.4), versus 12.4% (95% CI 8.2 to 16.7) for scores less than 4.

INTERPRETATION:

Our study identified predictors of critical care admission and death in people admitted to hospital with COVID-19. These predictors were incorporated into a risk score that will inform clinical care and stratify patients for clinical trials.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Critical Care / Hospitalization Type of study: Cohort study / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: Europa Language: English Journal: J Infect Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Critical Care / Hospitalization Type of study: Cohort study / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: Europa Language: English Journal: J Infect Year: 2020 Document Type: Article