Abstract
Prognostic factors of coronavirus disease 2019 (COVID-19) patients among European population are lacking. Our objective was to identify early prognostic factors upon admission to optimize the management of COVID-19 patients hospitalized in a medical ward. This French single-center prospective cohort study evaluated 152 patients with positive severe acute respiratory syndrome coronavirus 2 real-time reverse transcriptase-polymerase chain reaction assay, hospitalized in the Internal Medicine and Clinical Immunology Department, at Pitié-Salpêtrière's Hospital, in Paris, France, a tertiary care university hospital. Predictive factors of intensive care unit (ICU) transfer or death at day 14 (D14), of being discharge alive and severe status at D14 (remaining with ventilation, or death) were evaluated in multivariable logistic regression models; models' performances, including discrimination and calibration, were assessed (C-index, calibration curve, R2, Brier score). A validation was performed on an external sample of 132 patients hospitalized in a French hospital close to Paris, in Aulnay-sous-Bois, Île-de-France. The probability of ICU transfer or death was 32% (47/147) (95% CI 25-40). Older age (OR 2.61, 95% CI 0.96-7.10), poorer respiratory presentation (OR 4.04 per 1-point increment on World Health Organization (WHO) clinical scale, 95% CI 1.76-9.25), higher CRP-level (OR 1.63 per 100mg/L increment, 95% CI 0.98-2.71) and lower lymphocytes count (OR 0.36 per 1000/mm3 increment, 95% CI 0.13-0.99) were associated with an increased risk of ICU requirement or death. A 9-point ordinal scale scoring system defined low (score 0-2), moderate (score 3-5), and high (score 6-8) risk patients, with predicted respectively 2%, 25% and 81% risk of ICU transfer or death at D14. Therefore, in this prospective cohort study of laboratory-confirmed COVID-19 patients hospitalized in a medical ward in France, a simplified scoring system at admission predicted the outcome at D14.
Highlights
In January 2020, the World Health Organization (WHO) declared the outbreak of coronavirus disease 2019 (COVID-19) to be a Public Health Emergency of International Concern [1]
Very limited prospective data is available on outcome and prognostic factors of COVID-19 patients among European population. Our objective through this French single-center prospective cohort study of 152 COVID-19 patients was to develop and validate multivariable predictive models for the patient status at day 14, i.e. (i) major clinical worsening, (ii) severe status at day 14, and (iii) favorable hospital outcome, in adult patients requiring initial hospitalization in a medical ward. This is a prospective single-center observational cohort study of 152 COVID-19 adult patients admitted from March 16th 2020 till the 4th of April in the Internal Medicine and Clinical Immunology Department, at Pitie-Salpêtrière’s Hospital, in Paris, France, a tertiary care university hospital
The estimated probability of Intensive care unit (ICU) transfer or death by day 14 (D14) was 32%, the estimated probability of still needing non-invasive ventilation (NIV) or mechanical ventilation (MV), or being dead, at D14 was 27%, while the estimated probability of being discharged alive by D14 was 58%
Summary
In January 2020, the World Health Organization (WHO) declared the outbreak of coronavirus disease 2019 (COVID-19) to be a Public Health Emergency of International Concern [1]. This outbreak started in China (Wuhan), from where most of the data is available to now. Intensive care unit (ICU) admissions range from 5% to 16%, depending on characteristics of the studied population [5, 6]. First in Italy in France, the outbreak rapidly overwhelmed the public health system and ICUs were filled. As of May 12th 2020, France had already confirmed 177.547 cases with 26.646 deaths [11]
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