Derivation and validation of the clinical prediction model for COVID-19
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IM - ORIGINAL
Derivation and validation of the clinical prediction model for COVID‑19 Fabrizio Foieni1 · Girolamo Sala1 · Jason Giuseppe Mognarelli2,4 · Giulia Suigo3 · Davide Zampini2 · Matteo Pistoia1 · Mariella Ciola1 · Tommaso Ciampani1 · Carolina Ultori1 · Paolo Ghiringhelli1 Received: 16 May 2020 / Accepted: 7 July 2020 © The Author(s) 2020
Abstract The epidemic phase of Coronavirus disease 2019 (COVID-19) made the Worldwide health system struggle against a severe interstitial pneumonia requiring high-intensity care settings for respiratory failure. A rationalisation of resources and a specific treatment path were necessary. The study suggests a predictive model drawing on clinical data gathered by 119 consecutive patients with laboratory-confirmed COVID-19 admitted in Busto Arsizio hospital. We derived a score that identifies the risk of clinical evolution and in-hospital mortality clustering patients into four groups. The study outcomes have been compared across the derivation and validation samples. The prediction rule is based on eight simple patient characteristics that were independently associated with study outcomes. It is able to stratify COVID-19 patients into four severity classes, with in-hospital mortality rates of 0% in group 1, 6–12.5% in group 2, 7–20% in group 3 and 60–86% in group 4 across the derivation and validation sample. The prediction model derived in this study identifies COVID-19 patients with low risk of in-hospital mortality and ICU admission. The prediction model that the study presents identifies COVID-19 patients with low risk of in-hospital mortality and admission to ICU. Moreover, it establishes an intermediate portion of patients that should be treated accurately in order to avoid an unfavourable clinical evolution. A further validation of the model is important before its implementation as a decision-making tool to guide the initial management of patients. Keywords Covid-19 · Critical illness · Derivation score · Validation score · Score · Predictive-markers · Sars-CoV2
Introduction
Memorial: This work was made in order to remind people of Roberto Stella (family doctor) and health care workers who gave their lives in the care of COVID-19 patients. * Fabrizio Foieni fabrizio.foieni@asst‑valleolona.it * Jason Giuseppe Mognarelli [email protected] Girolamo Sala girolamo.sala@asst‑valleolona.it 1
Internal Medicine, Busto Arsizio Hospital, ASST Valle Olona, Busto Hospital, Varese, Lombardy, Italy
2
Vascular Surgery, ASST Valle Olona, Busto Hospital, Varese, Lombardy, Italy
3
Pneumology, ASST Valle Olona, Busto Hospital, Varese, Lombardy, Italy
4
School of Vascular Surgery, Università degli Studi di Milano, Milan, Italy
Coronavirus disease 2019 (COVID-19) is the third coronavirus infection of the past two decades, after severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) [1, 2]. As the COVID-19 pandemic spreads worldwide, intensive care unit (ICU) practitioners, hospital administrators, governments, policy makers,
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