A Predictive Model and Risk Factors for Case Fatality of COVID-19

Melchor Álvarez-Mon, Miguel A Ortega, Óscar Gasulla, Jordi Fortuny-Profitós, Ferran A Mazaira-Font, Pablo Saurina, Jorge Monserrat, María N Plana, Daniel Troncoso, José Sanz Moreno, Benjamin Muñoz, Alberto Arranz, Jose F Varona, Alejandro Lopez-Escobar, Angel Asúnsolo-Del Barco, Melchor Álvarez-Mon, Miguel A Ortega, Óscar Gasulla, Jordi Fortuny-Profitós, Ferran A Mazaira-Font, Pablo Saurina, Jorge Monserrat, María N Plana, Daniel Troncoso, José Sanz Moreno, Benjamin Muñoz, Alberto Arranz, Jose F Varona, Alejandro Lopez-Escobar, Angel Asúnsolo-Del Barco

Abstract

This study aimed to create an individualized analysis model of the risk of intensive care unit (ICU) admission or death for coronavirus disease 2019 (COVID-19) patients as a tool for the rapid clinical management of hospitalized patients in order to achieve a resilience of medical resources. This is an observational, analytical, retrospective cohort study with longitudinal follow-up. Data were collected from the medical records of 3489 patients diagnosed with COVID-19 using RT-qPCR in the period of highest community transmission recorded in Europe to date: February-June 2020. The study was carried out in in two health areas of hospital care in the Madrid region: the central area of the Madrid capital (Hospitales de Madrid del Grupo HM Hospitales (CH-HM), n = 1931) and the metropolitan area of Madrid (Hospital Universitario Príncipe de Asturias (MH-HUPA) n = 1558). By using a regression model, we observed how the different patient variables had unequal importance. Among all the analyzed variables, basal oxygen saturation was found to have the highest relative importance with a value of 20.3%, followed by age (17.7%), lymphocyte/leukocyte ratio (14.4%), CRP value (12.5%), comorbidities (12.5%), and leukocyte count (8.9%). Three levels of risk of ICU/death were established: low-risk level (<5%), medium-risk level (5-20%), and high-risk level (>20%). At the high-risk level, 13% needed ICU admission, 29% died, and 37% had an ICU-death outcome. This predictive model allowed us to individualize the risk for worse outcome for hospitalized patients affected by COVID-19.

Keywords: C-reactive protein; COVID-19; ICU; death; oxygen saturation; predictive model.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Graphic representation to classify the importance of the study variables in relation to admission to the ICU and death. Three levels of risk are described in this model: low (<5%), moderate (5–20%), and high (>20%). The results are expressed as mean (standard deviation). CRP = C-reactive protein mean, ICU = intensive care unit.

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