Risk Factors and Predictive Scoring System Development for COVID-19 Death

ABSTRACT

Background: The COVID-19 has become a global epidemic.How to effectively treat it and reduce the fatality rate is still at exploratory stage.Identification of risk factors for death is critical to optimize treatment strategies for COVID-19.Objective: To investigate risk factors for COVID-19 death, and based on this, to develop a COVID-19 death predictive scoring system.Methods: Two hundred and seventy patients, who discharged or deceased with confirmed COVID-19 in Zhongnan Hospital of Wuhan University during January 1 to February 29, 2020, were reviewed.Baseline data were obtained, including demographics, admission symptoms and vital signs, complications and laboratory test results.According to the clinical outcome, i.e.discharged and deceased, the patients were divided into recovery group and death group.Risk factors of death were explored by using multivariate logistic regression analysis, and used for the development of a predictive scoring system for death.Results Two hundred and forty-five cases were finally included, including 212 discharged and 33 deceased during hospitalization.Factors independently associated with death were age ≥ 65 years〔OR=7.177, 95%CI(1.715, 30.038), P<0.05〕, SpO2≤93%〔OR=15.456, 95%CI(3.343, 71.450), P<0.05〕, BUN≥7 mmol/L〔OR=7.115, 95%CI(1.550, 32.652), P<0.05〕, PCT≥0.1 μg/L〔OR=23.895, 95%CI(4.209, 135.639), P<0.05〕.In predicting death due to COVID-19, the AUC of ASBP(A age, S SpO2, B BUN, P PCT) scoring system was 0.967〔95%CI(0.931, 0.987)〕, and that of CURB-65 scoring system was 0.885〔95%CI(0.831, 0.926)〕, showing a significant difference(Z=2.816, P<0.01).5 was the maximal Youden Index for ASBP scoring system and was chosen as the cut-off value, with 0.871 sensitivity and 0.957 specificity.And 2 was the maximal Youden Index for CURB-65 scoring system and was chosen as the cut-off value, with 0.903 sensitivity and 0.735 specificity.Conclusion: Older age, lower SpO2, higher levels of BUN and PCT were independent risk factors for COVID-19 death, and the ASBP scoring system developed based these factors might be available for the assessment of death risk of COVID-19. Copyright © 2020 by the Chinese General Practice.