Abstract
BackgroundCOVID-19 pandemic has forced physicians to quickly determine the patient’s condition and choose treatment strategies. This study aimed to build and validate a simple tool that can quickly predict the deterioration and survival of COVID-19 patients.MethodsA total of 351 COVID-19 patients admitted to the Third People’s Hospital of Yichang between 9 January to 25 March 2020 were retrospectively analyzed. Patients were randomly grouped into training (n = 246) or a validation (n = 105) dataset. Risk factors associated with deterioration were identified using univariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression. The factors were then incorporated into the nomogram. Kaplan-Meier analysis was used to compare the survival of patients between the low- and high-risk groups divided by the cut-off point.ResultsThe least absolute shrinkage and selection operator (LASSO) regression was used to construct the nomogram via four parameters (white blood cells, C-reactive protein, lymphocyte≥0.8 × 109/L, and lactate dehydrogenase ≥400 U/L). The nomogram showed good discriminative performance with the area under the receiver operating characteristic (AUROC) of 0.945 (95% confidence interval: 0.91–0.98), and good calibration (P = 0.539). Besides, the nomogram showed good discrimination performance and good calibration in the validation and total cohorts (AUROC = 0.979 and AUROC = 0.954, respectively). Decision curve analysis demonstrated that the model had clinical application value. Kaplan-Meier analysis illustrated that low-risk patients had a significantly higher 8-week survival rate than those in the high-risk group (100% vs 71.41% and P < 0.0001).ConclusionA simple-to-use nomogram with excellent performance in predicting deterioration risk and survival of COVID-19 patients was developed and validated. However, it is necessary to verify this nomogram using a large-scale multicenter study.
Highlights
The respiratory disease coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus type 2 (SARS-CoV-2) has been spreading globally since December 2019 [1, 2]
This study included only patients with positive fluorescence reverse transcriptionpolymerase chain reaction (RT-PCR) assay results of nasal and pharyngeal swab specimens or specific IgM or IgG antibodies in serum
Despite continuous renal replacement therapy (CRRT), baseline characteristics of both cohorts were comparable, indicating that they could be used as training and validation cohorts
Summary
The respiratory disease coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus type 2 (SARS-CoV-2) has been spreading globally since December 2019 [1, 2]. COVID-19 information is becoming more detailed as clinical cases increase. Some COVID19 patients get worse due to progressive pneumonia, severe dyspnea, gastrointestinal bleeding, or multiple organ failure, and even die [3,4,5]. There are no drugs for the COVID-19 treatment [6,7,8,9]. It is urgent to determine factors to quickly predict the deterioration of COVID-19 patients. COVID-19 pandemic has forced physicians to quickly determine the patient’s condition and choose treatment strategies. This study aimed to build and validate a simple tool that can quickly predict the deterioration and survival of COVID-19 patients
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