The shortage of recently approved vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has highlighted the need for evidence-based tools to prioritize healthcare resources for people at higher risk of severe coronavirus disease (COVID-19). Although age has been identified as the most important risk factor (particularly for mortality), the contribution of underlying comorbidities is often assessed using a pre-defined list of chronic conditions. Furthermore, the count of individual risk factors has limited applicability to population-based “stratify-and-shield” strategies. We aimed to develop and validate a COVID-19 risk stratification system that allows allocating individuals of the general population into four mutually-exclusive risk categories based on multivariate models for severe COVID-19, a composite of hospital admission, transfer to intensive care unit (ICU), and mortality among the general population. The model was developed using clinical, hospital, and epidemiological data from all individuals among the entire population of Catalonia (North-East Spain; 7.5 million people) who experienced a COVID-19 event (i.e., hospitalization, ICU admission, or death due to COVID-19) between March 1 and September 15, 2020, and validated using an independent dataset of 218,329 individuals with COVID-19 confirmed by reverse transcription—polymerase chain reaction (RT-PCR), who were infected after developing the model. No exclusion criteria were defined. The final model included age, sex, a summary measure of the comorbidity burden, the socioeconomic status, and the presence of specific diagnoses potentially associated with severe COVID-19. The validation showed high discrimination capacity, with an area under the curve of the receiving operating characteristics of 0.85 (95% CI 0.85–0.85) for hospital admissions, 0.86 (0.86–0.97) for ICU transfers, and 0.96 (0.96–0.96) for deaths. Our results provide clinicians and policymakers with an evidence-based tool for prioritizing COVID-19 healthcare resources in other population groups aside from those with higher exposure to SARS-CoV-2 and frontline workers.
【저자키워드】 Risk factors, Health care, 【초록키워드】 COVID-19, SARS-CoV-2, Vaccine, coronavirus, Mortality, intensive care, severe COVID-19, Hospitalization, hospital, Comorbidity, Sex, risk factor, RT-PCR, ICU, risk stratification, Characteristics, healthcare, ICU admission, death, age, dataset, Hospital admission, epidemiological data, General population, group, resource, deaths, chronic conditions, Hospital admissions, exclusion criteria, acute respiratory syndrome, higher risk, 95% CI, clinician, severe coronavirus disease, individual, multivariate model, transfer, Final, applicability, independent, Risk category, defined, were infected, develop, approved, receiving, individuals with COVID-19, specific diagnose, 【제목키워드】 severe COVID-19, risk stratification, General population, development,