ACP Risk Grade: A Simple Mortality Index for Patients with Confirmed or Suspected Severe Acute Respiratory Syndrome Coronavirus 2 Disease (COVID-19) During the Early Stage of Outbreak in Wuhan, China

Abstract

Background: Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) outbreaks in Wuhan, China, healthcare systems capacities in highly endemic areas have been overwhelmed. Approaches to efficient management are urgently needed and key to a quicker control of the outbreaks and casualties. We aimed to characterize the clinical features of hospitalized patients with confirmed or suspected COVID-19, and develop a mortality risk index for COVID-19 patients. Methods: In this retrospective one-centre cohort study, we included all the confirmed or suspected COVID-19 patients hospitalized in a COVID-19-designated hospital from January 21 to February 5, 2020. Demographic, clinical, laboratory, radiological and clinical outcome data were collected from the hospital information system, nursing records and laboratory reports. Findings: Of 577 patients with at least one post-admission evaluation, the median age was 55 years (interquartile range [IQR], 39 - 66); 254 (44·0%) were men; 22·8% (100/438) were severe pneumonia on admission, and 37·7% (75/199) patients were SARS-CoV-2 positive. The clinical, laboratory and radiological data were comparable between positive and negative SARS-CoV-2 patients. During a median follow-up of 8·4 days (IQR, 5·8 - 12·0), 39 patients died with a 12-day cumulative mortality of 8·7% (95% CI, 5·9% to 11·5%). A simple mortality risk index (called ACP index), composed of Age and C-reactive Protein, was developed. By applying the ACP index, patients were categorized into three grades. The 12-day cumulative mortality in grade three (age ≥ 60 years and CRP ≥ 34 mg/L) was 33·2% (95% CI, 19·8% to 44·3%), which was significantly higher than those of grade two (age ≥ 60 years and CRP < 34 mg/L; age < 60 years and CRP ≥ 34 mg/L; 5·6% [95% CI, 0 to 11·3%]) and grade one (age < 60 years and CRP < 34 mg/L, 0%) (P <0·001), respectively. Interpretation: The ACP index can predict COVID-19 related short-term mortality, which may be a useful and convenient tool for quickly establishing a COVID-19 hierarchical management system that can greatly reduce the medical burden and therefore mortality in highly endemic areas. Funding Statement: Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program. Declaration of Interests: The authors stated: None reported. Ethics Approval Statement: The study was conducted in accordance with the guidelines of the Declaration of Helsinki and the principles of good clinical practice, and was approved by the Nanfang Hospital Ethics Committee (NFEC-2020-026).