Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19
Open accessAbstract
Importance: Early identification of patients with novel coronavirus disease 2019 (COVID-19) who may develop critical illness is of great importance and may aid in delivering proper treatment and optimizing use of resources. Objective: To develop and validate a clinical score at hospital admission for predicting which patients with COVID-19 will develop critical illness based on a nationwide cohort in China. Design, Setting, and Participants: Collaborating with the National Health Commission of China, we established a retrospective cohort of patients with COVID-19 from 575 hospitals in 31 provincial administrative regions as of January 31, 2020. Epidemiological, clinical, laboratory, and imaging variables ascertained at hospital admission were screened using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive risk score (COVID-GRAM). The score provides an estimate of the risk that a hospitalized patient with COVID-19 will develop critical illness. Accuracy of the score was measured by the area under the receiver operating characteristic curve (AUC). Data from 4 additional cohorts in China hospitalized with COVID-19 were used to validate the score. Data were analyzed between February 20, 2020 and March 17, 2020. Main Outcomes and Measures: Among patients with COVID-19 admitted to the hospital, critical illness was defined as the composite measure of admission to the intensive care unit, invasive ventilation, or death. Results: The development cohort included 1590 patients. the mean (SD) age of patients in the cohort was 48.9 (15.7) years; 904 (57.3%) were men. The validation cohort included 710 patients with a mean (SD) age of 48.2 (15.2) years, and 382 (53.8%) were men and 172 (24.2%). From 72 potential predictors, 10 variables were independent predictive factors and were included in the risk score: chest radiographic abnormality (OR, 3.39; 95% CI, 2.14-5.38), age (OR, 1.03; 95% CI, 1.01-1.05), hemoptysis (OR, 4.53; 95% CI, 1.36-15.15), dyspnea (OR, 1.88; 95% CI, 1.18-3.01), unconsciousness (OR, 4.71; 95% CI, 1.39-15.98), number of comorbidities (OR, 1.60; 95% CI, 1.27-2.00), cancer history (OR, 4.07; 95% CI, 1.23-13.43), neutrophil-to-lymphocyte ratio (OR, 1.06; 95% CI, 1.02-1.10), lactate dehydrogenase (OR, 1.002; 95% CI, 1.001-1.004) and direct bilirubin (OR, 1.15; 95% CI, 1.06-1.24). The mean AUC in the development cohort was 0.88 (95% CI, 0.85-0.91) and the AUC in the validation cohort was 0.88 (95% CI, 0.84-0.93). The score has been translated into an online risk calculator that is freely available to the public (http://118.126.104.170/). Conclusions and Relevance: In this study, a risk score based on characteristics of COVID-19 patients at the time of admission to the hospital was developed that may help predict a patient's risk of developing critical illness.
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The CDS model used chest X-ray images, vital signs, demographic data, and laboratory values that prior publications showed to be predictive of COVID-19 outcomes.
“The inputs to the CDS model were Chest X-Ray (CXR) images, vital signs, demographic data, and lab values that were shown in previous publications to be predictive of COVID-19 patient outcomes18–21.”
From Federated learning for predicting clinical outcomes in patients with COVID-19 (2021) · cites this paper as [18]
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- Authors
- Liang, W., Liang, H., Ou, L., Chen, B., Chen, A., Li, C., Li, Y., Guan, W., Sang, L., Lu, J., Xu, Y., Chen, G., Guo, H., Guo, J., Chen, Z., Zhao, Y., Li, S., Zhang, N., Zhong, N., He, J., & for the China Medical Treatment Expert Group for COVID-19
- Affiliations
- First Affiliated Hospital of Guangzhou Medical University (CN)
- Sun Yat-sen University (CN)
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Jinyintan Hospital (CN)
- Wuhan Hankou Hospital (CN)
- First People's Hospital of Foshan (CN)
- Nanhai Hospital, Foshan, China
- Daye People's Hospital (CN)
- Corresponding author
- He, Jianxing
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2020-08-01
- Volume
- 180
- Issue
- 8
- Pages
- 1081
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC7218676
- OpenAlex
- W3024853795
- Cited by
- 1,387
- References
- 10
- Citations by year
- 2026: 42 · 2025: 53 · 2024: 128 · 2023: 171 · 2022: 273 · 2021: 458 · 2020: 260
- FWCI
- 38.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- COVID-19 pandemic, critical illness prediction, clinical risk score, hospitalized patients, intensive care unit admission, invasive mechanical ventilation, mortality, chest X-ray abnormalities, hemoptysis, dyspnea, prognostic factors, risk stratification, LASSO feature selection, model validation, China, COVID-19 pneumonia, resource allocation
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, COVID-19 Testing, Adult, Aged, China, Critical Care, Female, Hospitalization, Humans, Male, Middle Aged, Pneumonia, Viral, Cohort Studies, Critical Illness, Coronavirus Infections, Risk Assessment, Clinical Laboratory Techniques, Pandemics
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