Modelling the risk of hospital admission of lab confirmed SARS-CoV-2-infected patients in primary care: a population-based study

Janire Portuondo-Jimenez, Amaia Bilbao-González, Verónica Tíscar-González, Ignacio Garitano-Gutiérrez, Susana García-Gutiérrez, Almudena Martínez-Mejuto, Jaione Santiago-Garin, Silvia Arribas-García, Julia García-Asensio, Johnny Chart-Pascual, Iñaki Zorrilla-Martínez, Jose Maria Quintana-Lopez, COVID-19-Osakidetza Working group, Janire Portuondo-Jimenez, Amaia Bilbao-González, Verónica Tíscar-González, Ignacio Garitano-Gutiérrez, Susana García-Gutiérrez, Almudena Martínez-Mejuto, Jaione Santiago-Garin, Silvia Arribas-García, Julia García-Asensio, Johnny Chart-Pascual, Iñaki Zorrilla-Martínez, Jose Maria Quintana-Lopez, COVID-19-Osakidetza Working group

Abstract

The objectives of this study are to develop a predictive model of hospital admission for COVID-19 to help in the activation of emergency services, early referrals from primary care, and the improvement of clinical decision-making in emergency room services. The method is the retrospective cohort study of 49,750 patients with microbiological confirmation of SARS-CoV-2 infection. The sample was randomly divided into two subsamples, for the purposes of derivation and validation of the prediction rule (60% and 40%, respectively). Data collected for this study included sociodemographic data, baseline comorbidities, baseline treatments, and other background data. Multilevel analyses with generalized estimated equations were used to develop the predictive model. Male sex and the gradual effect of age were the main risk factors for hospital admission. Regarding baseline comorbidities, coagulopathies, cancer, cardiovascular diseases, diabetes with organ damage, and liver disease were among the five most notable. Flu vaccination was a risk factor for hospital admission. Drugs that increased risk were chronic systemic steroids, immunosuppressants, angiotensin-converting enzyme inhibitors, and NSAIDs. The AUC of the risk score was 0.821 and 0.828 in the derivation and validation samples, respectively. Based on the risk score, five risk groups were derived with hospital admission ranging from 2.94 to 51.87%. In conclusion, we propose a classification system for people with COVID-19 with a higher risk of hospitalization, and indirectly with it a greater severity of the disease, easy to be completed both in primary care, as well as in emergency services and in hospital emergency room to help in clinical decision-making.Registration: ClinicalTrials.gov Identifier: NCT04463706.

Keywords: Coronavirus infections; Emergencies; Epidemiology; Primary health care; Risk factors.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

Figures

Fig. 1
Fig. 1
ROC curves for the risk score in both derivation and validations samples, and k-fold cross-validation

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