Abstract
Clinical and laboratory predictors of COVID-19 severity are now well described and combined to propose mortality or severity scores. However, they all necessitate saturable equipment such as scanners, or procedures difficult to implement such as blood gas measures. To provide an easy and fast COVID-19 severity risk score upon hospital admission, and keeping in mind the above limits, we sought for a scoring system needing limited invasive data such as a simple blood test and co-morbidity assessment by anamnesis. A retrospective study of 303 patients (203 from Bordeaux University hospital and an external independent cohort of 100 patients from Paris Pitié-Salpêtrière hospital) collected clinical and biochemical parameters at admission. Using stepwise model selection by Akaike Information Criterion (AIC), we built the severity score Covichem. Among 26 tested variables, 7: obesity, cardiovascular conditions, plasma sodium, albumin, ferritin, LDH and CK were the independent predictors of severity used in Covichem (accuracy 0.87, AUROC 0.91). Accuracy was 0.92 in the external validation cohort (89% sensitivity and 95% specificity). Covichem score could be useful as a rapid, costless and easy to implement severity assessment tool during acute COVID-19 pandemic waves.
Highlights
About 14% of patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) need hospitalization and oxygen support and 5% require admission to an intensive care unit [1]
While albumin was found inversely correlated and lactate dehydrogenase (LDH) and C-reactive protein (CRP) positively correlated with Murray scores documenting the severity of lung injury [9], the combination of these parameters upon hospital admission was not tested as a predictive factor of COVID-19 severity
COVID-19 was severe for 97 patients (48%, Table 1)
Summary
About 14% of patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) need hospitalization and oxygen support and 5% require admission to an intensive care unit [1]. As in April 2020, blood routine parameters were found to provide important information for the severity of disease since they were significantly different between non-severe and severe types of COVID-19 patients. A meta-analysis assessed the value of mortality and severity scores, published in 30 studies [6]. 4 peer-reviewed articles report scores associated to severity; among them two scores used blood markers to predict disease severity at hospital admission [7, 8]. While albumin was found inversely correlated and lactate dehydrogenase (LDH) and C-reactive protein (CRP) positively correlated with Murray scores documenting the severity of lung injury [9], the combination of these parameters upon hospital admission was not tested as a predictive factor of COVID-19 severity
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