Abstract

COVID-19 pandemic has created an extreme pressure on the global healthcare services. Fast, reliable, and early clinical assessment of the severity of the disease can help in allocating and prioritizing resources to reduce mortality. In order to study the important blood biomarkers for predicting disease mortality, a retrospective study was conducted on a dataset made public by Yan et al. in [1] of 375 COVID-19 positive patients admitted to Tongji Hospital (China) from January 10 to February 18, 2020. Demographic and clinical characteristics and patient outcomes were investigated using machine learning tools to identify key biomarkers to predict the mortality of individual patient. A nomogram was developed for predicting the mortality risk among COVID-19 patients. Lactate dehydrogenase, neutrophils (%), lymphocyte (%), high-sensitivity C-reactive protein, and age (LNLCA)—acquired at hospital admission—were identified as key predictors of death by multi-tree XGBoost model. The area under curve (AUC) of the nomogram for the derivation and validation cohort were 0.961 and 0.991, respectively. An integrated score (LNLCA) was calculated with the corresponding death probability. COVID-19 patients were divided into three subgroups: low-, moderate-, and high-risk groups using LNLCA cutoff values of 10.4 and 12.65 with the death probability less than 5%, 5–50%, and above 50%, respectively. The prognostic model, nomogram, and LNLCA score can help in early detection of high mortality risk of COVID-19 patients, which will help doctors to improve the management of patient stratification.

Highlights

  • The novel coronavirus disease (COVID-19) spread rapidly throughout the world from Wuhan (Hubei, China) since December 2019 [2,3,4,5,6]

  • On 11 March 2020, COVID-19 was declared as a pandemic by the World Health Organization (WHO) [8]

  • There is no scoring system reported in this work, which can help the clinicians to identify the patients under risk quantitatively

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Summary

Introduction

The novel coronavirus disease (COVID-19) spread rapidly throughout the world from Wuhan (Hubei, China) since December 2019 [2,3,4,5,6]. The COVID-19 disease is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is a member of the coronavirus family. On 11 March 2020, COVID-19 was declared as a pandemic by the World Health Organization (WHO) [8]. Hospital capacity is being exceeded in many places and face issues in terms of limited medical staff, personal protective equipment, life-support equipment, and others [9, 10]. Symptoms of COVID-19 are non-specific, and infected individuals may develop fever (83–99%), cough (59–82%), loss of appetite (40–84%), fatigue (44–70%), shortness of breath (31–40%), coughing up sputum (28–33%), or muscle

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