Abstract
Background: Coronavirus disease 2019 (COVID-19) is a highly variable condition. Validated tools to assist in the early detection of patients at high risk of mortality can help guide medical decisions.
Objective: We sought to validate externally, as well as in patients from the second pandemic wave in Europe, our previously developed mortality prediction model for hospitalized COVID-19 patients.
Methods: Three validation cohorts were generated: 2 external with 185 and 730 patients from the first wave and 1 internal with 119 patients from the second wave. The probability of death was calculated for all subjects using our prediction model, which includes peripheral blood oxygen saturation/fraction of inspired oxygen ratio, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, IL-6, and age. Discrimination and calibration were evaluated in the validation cohorts. The prediction model was updated by reestimating individual risk factor effects in the overall cohort (N = 1477).
Results: The mortality prediction model showed good performance in the external validation cohorts 1 and 2, and in the second wave validation cohort 3 (area under the receiver-operating characteristic curve, 0.94, 0.86, and 0.86, respectively), with excellent calibration (calibration slope, 0.86, 0.94, and 0.79; intercept, 0.05, 0.03, and 0.10, respectively). The updated model accurately predicted mortality in the overall cohort (area under the receiver-operating characteristic curve, 0.91), which included patients from both the first and second COVID-19 waves. The updated model was also useful to predict fatal outcome in patients without respiratory distress at the time of evaluation.
Conclusions: This is the first COVID-19 mortality prediction model validated in patients from the first and second pandemic waves. The COR+12 online calculator is freely available to facilitate its implementation (https://utrero-rico.shinyapps.io/COR12_Score/).
Keywords: COVID-19; IL-6; external validation; mortality risk; predictive model; second wave.
【저자키워드】 COVID-19, IL-6, Predictive model, second wave, mortality risk, external validation, 【초록키워드】 coronavirus disease, Coronavirus disease 2019, Europe, pandemic, Mortality, IL-6, neutrophil, oxygen, outcome, risk factor, lactate dehydrogenase, Neutrophil-to-lymphocyte ratio, Peripheral blood, Probability, lymphocyte, Cohort, implementation, Early detection, Patient, death, second wave, age, discrimination, characteristic, First wave, predict, Lactate, mortality risk, distress, COVID-19 mortality, external validation, high risk, Predictive, respiratory distress, hospitalized COVID-19 patients, all subjects, calibration, help, validation cohort, validation cohorts, calibration slope, Effect, predicted, include, evaluated, facilitate, calculated, assist, all subject, calculator, 【제목키워드】 Mortality, Cohort, validation, multicenter,