Abstract
The epidemic phase of Coronavirus disease 2019 (COVID-19) made the Worldwide health system struggle against a severe interstitial pneumonia requiring high-intensity care settings for respiratory failure. A rationalisation of resources and a specific treatment path were necessary. The study suggests a predictive model drawing on clinical data gathered by 119 consecutive patients with laboratory-confirmed COVID-19 admitted in Busto Arsizio hospital. We derived a score that identifies the risk of clinical evolution and in-hospital mortality clustering patients into four groups. The study outcomes have been compared across the derivation and validation samples. The prediction rule is based on eight simple patient characteristics that were independently associated with study outcomes. It is able to stratify COVID-19 patients into four severity classes, with in-hospital mortality rates of 0% in group 1, 6–12.5% in group 2, 7–20% in group 3 and 60–86% in group 4 across the derivation and validation sample. The prediction model derived in this study identifies COVID-19 patients with low risk of in-hospital mortality and ICU admission. The prediction model that the study presents identifies COVID-19 patients with low risk of in-hospital mortality and admission to ICU. Moreover, it establishes an intermediate portion of patients that should be treated accurately in order to avoid an unfavourable clinical evolution. A further validation of the model is important before its implementation as a decision-making tool to guide the initial management of patients.
Highlights
Coronavirus disease 2019 (COVID-19) is the third coronavirus infection of the past two decades, after severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) [1, 2]
As the COVID-19 pandemic spreads worldwide, intensive care unit (ICU) practitioners, hospital administrators, governments, policy makers, and researchers must prepare for a surge in critically ill patients
97% of patients on invasive mechanical ventilation died in a multicenter study conducted early in the Wuhan outbreak, mortality is affected by local practices, and larger studies are awaited
Summary
Coronavirus disease 2019 (COVID-19) is the third coronavirus infection of the past two decades, after severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) [1, 2]. As the COVID-19 pandemic spreads worldwide, intensive care unit (ICU) practitioners, hospital administrators, governments, policy makers, and researchers must prepare for a surge in critically ill patients. The number of people with COVID-19 worldwide crossed the one million mark on April 2, 2020; the case fatality rate across 204 countries and territories was 5·2% [3]. 49% of all 2087 critically ill patients with COVID19 in China died [4, 5]. Single-ICU studies found mortality rates of 62% (in Wuhan, China) and 52% (in Washington, DC, USA), but these figures had not accounted for many who were still in the ICU. 97% of patients on invasive mechanical ventilation died in a multicenter study conducted early in the Wuhan outbreak, mortality is affected by local practices, and larger studies are awaited
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