Abstract
Background: In locations where few people have received coronavirus disease 2019 (COVID-19) vaccines, health systems remain vulnerable to surges in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Tools to identify patients suitable for community-based management are urgently needed.
Methods: We prospectively recruited adults presenting to 2 hospitals in India with moderate symptoms of laboratory-confirmed COVID-19 to develop and validate a clinical prediction model to rule out progression to supplemental oxygen requirement. The primary outcome was defined as any of the following: SpO2 < 94%; respiratory rate > 30 BPM; SpO2/FiO2 < 400; or death. We specified a priori that each model would contain three clinical parameters (age, sex, and SpO2) and 1 of 7 shortlisted biochemical biomarkers measurable using commercially available rapid tests (C-reactive protein [CRP], D-dimer, interleukin 6 [IL-6], neutrophil-to-lymphocyte ratio [NLR], procalcitonin [PCT], soluble triggering receptor expressed on myeloid cell-1 [sTREM-1], or soluble urokinase plasminogen activator receptor [suPAR]), to ensure the models would be suitable for resource-limited settings. We evaluated discrimination, calibration, and clinical utility of the models in a held-out temporal external validation cohort.
Results: In total, 426 participants were recruited, of whom 89 (21.0%) met the primary outcome; 257 participants comprised the development cohort, and 166 comprised the validation cohort. The 3 models containing NLR, suPAR, or IL-6 demonstrated promising discrimination (c-statistics: 0.72-0.74) and calibration (calibration slopes: 1.01-1.05) in the validation cohort and provided greater utility than a model containing the clinical parameters alone.
Conclusions: We present 3 clinical prediction models that could help clinicians identify patients with moderate COVID-19 suitable for community-based management. The models are readily implementable and of particular relevance for locations with limited resources.
Keywords: COVID-19; LMIC; low- and middle-income country; prognostic model; triage.
【저자키워드】 COVID-19, LMIC, triage., low- and middle-income country, prognostic model, 【초록키워드】 coronavirus disease, SARS-CoV-2, coronavirus, Biomarker, Vaccines, IL-6, hospital, suPAR, India, Sex, C-reactive protein, D-dimer, procalcitonin, Symptom, progression, Neutrophil-to-lymphocyte ratio, Cohort, infections, Rapid test, management, Patient, death, age, receptor, health system, prognostic, utility, moderate, NLR, external validation, respiratory rate, supplemental oxygen, acute respiratory syndrome, Primary outcome, SpO2, biochemical, clinician, help, clinical utility, participant, validation cohort, SpO2/FiO2, laboratory-confirmed, soluble Triggering Receptor, clinical parameter, resources, greater, defined, identify, develop, recruited, evaluated, provided, expressed, demonstrated, presenting, patients with moderate, 【제목키워드】 prediction, clinical, Prospective, Model, setting, Facilitating,