A clinical risk score to predict in-hospital mortality in critically ill patients with COVID-19: a retrospective cohort study
Objectives To identify factors influencing the mortality risk in critically ill patients with COVID-19, and to develop a risk prediction score to be used at admission to intensive care unit (ICU).Design A multicentre cohort study.Setting and participants 1542 patients with COVID-19 admitted to ICUs...
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BMJ Publishing Group
2021-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/8/e048770.full |
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| author | Imran Iqbal Abderrahim Oulhaj Javaid Nauman Salem Alkaabi Asma Alnuaimi Mariam Alharbi Mohammed A Amari Rajiv Ganapathy |
| author_facet | Imran Iqbal Abderrahim Oulhaj Javaid Nauman Salem Alkaabi Asma Alnuaimi Mariam Alharbi Mohammed A Amari Rajiv Ganapathy |
| author_sort | Imran Iqbal |
| collection | DOAJ |
| description | Objectives To identify factors influencing the mortality risk in critically ill patients with COVID-19, and to develop a risk prediction score to be used at admission to intensive care unit (ICU).Design A multicentre cohort study.Setting and participants 1542 patients with COVID-19 admitted to ICUs in public hospitals of Abu Dhabi, United Arab Emirates between 1 March 2020 and 22 July 2020.Main outcomes and measures The primary outcome was time from ICU admission until death. We used competing risk regression models and Least Absolute Shrinkage and Selection Operator to identify the factors, and to construct a risk score. Predictive ability of the score was assessed by the area under the receiver operating characteristic curve (AUC), and the Brier score using 500 bootstraps replications.Results Among patients admitted to ICU, 196 (12.7%) died, 1215 (78.8%) were discharged and 131 (8.5%) were right-censored. The cumulative mortality incidence was 14% (95% CI 12.17% to 15.82%). From 36 potential predictors, we identified seven factors associated with mortality, and included in the risk score: age (adjusted HR (AHR) 1.98; 95% CI 1.71 to 2.31), neutrophil percentage (AHR 1.71; 95% CI 1.27 to 2.31), lactate dehydrogenase (AHR 1.31; 95% CI 1.15 to 1.49), respiratory rate (AHR 1.31; 95% CI 1.15 to 1.49), creatinine (AHR 1.19; 95% CI 1.11 to 1.28), Glasgow Coma Scale (AHR 0.70; 95% CI 0.63 to 0.78) and oxygen saturation (SpO2) (AHR 0.82; 95% CI 0.74 to 0.91). The mean AUC was 88.1 (95% CI 85.6 to 91.6), and the Brier score was 8.11 (95% CI 6.74 to 9.60). We developed a freely available web-based risk calculator (https://icumortalityrisk.shinyapps.io/ICUrisk/).Conclusion In critically ill patients with COVID-19, we identified factors associated with mortality, and developed a risk prediction tool that showed high predictive ability. This tool may have utility in clinical settings to guide decision-making, and may facilitate the identification of supportive therapies to improve outcomes. |
| format | Article |
| id | doaj-art-dcbc81ebb0214e60aa6dcaf61e2bcd7c |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-08-01 |
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| series | BMJ Open |
| spelling | doaj-art-dcbc81ebb0214e60aa6dcaf61e2bcd7c2025-08-20T02:21:03ZengBMJ Publishing GroupBMJ Open2044-60552021-08-0111810.1136/bmjopen-2021-048770A clinical risk score to predict in-hospital mortality in critically ill patients with COVID-19: a retrospective cohort studyImran Iqbal0Abderrahim Oulhaj1Javaid Nauman2Salem Alkaabi3Asma Alnuaimi4Mariam Alharbi5Mohammed A Amari6Rajiv Ganapathy7SEHA, Abu Dhabi Health Services Co, Abu Dhabi, UAEInstitute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, Abu Dhabi, UAEInstitute of Public Health, College of Medicine and Health Sceinces, United Arab Emirates University, Al-Ain, UAECardiology Department, Sheikh Khalifa Medical City, Abu Dhabi, UAESheikh Khalifa Medical City, Abu Dhabi, UAESEHA, Abu Dhabi Health Services Co, Abu Dhabi, UAESheikh Khalifa Medical City, Abu Dhabi, UAECerner Middle East & Africa, Dubai, UAEObjectives To identify factors influencing the mortality risk in critically ill patients with COVID-19, and to develop a risk prediction score to be used at admission to intensive care unit (ICU).Design A multicentre cohort study.Setting and participants 1542 patients with COVID-19 admitted to ICUs in public hospitals of Abu Dhabi, United Arab Emirates between 1 March 2020 and 22 July 2020.Main outcomes and measures The primary outcome was time from ICU admission until death. We used competing risk regression models and Least Absolute Shrinkage and Selection Operator to identify the factors, and to construct a risk score. Predictive ability of the score was assessed by the area under the receiver operating characteristic curve (AUC), and the Brier score using 500 bootstraps replications.Results Among patients admitted to ICU, 196 (12.7%) died, 1215 (78.8%) were discharged and 131 (8.5%) were right-censored. The cumulative mortality incidence was 14% (95% CI 12.17% to 15.82%). From 36 potential predictors, we identified seven factors associated with mortality, and included in the risk score: age (adjusted HR (AHR) 1.98; 95% CI 1.71 to 2.31), neutrophil percentage (AHR 1.71; 95% CI 1.27 to 2.31), lactate dehydrogenase (AHR 1.31; 95% CI 1.15 to 1.49), respiratory rate (AHR 1.31; 95% CI 1.15 to 1.49), creatinine (AHR 1.19; 95% CI 1.11 to 1.28), Glasgow Coma Scale (AHR 0.70; 95% CI 0.63 to 0.78) and oxygen saturation (SpO2) (AHR 0.82; 95% CI 0.74 to 0.91). The mean AUC was 88.1 (95% CI 85.6 to 91.6), and the Brier score was 8.11 (95% CI 6.74 to 9.60). We developed a freely available web-based risk calculator (https://icumortalityrisk.shinyapps.io/ICUrisk/).Conclusion In critically ill patients with COVID-19, we identified factors associated with mortality, and developed a risk prediction tool that showed high predictive ability. This tool may have utility in clinical settings to guide decision-making, and may facilitate the identification of supportive therapies to improve outcomes.https://bmjopen.bmj.com/content/11/8/e048770.full |
| spellingShingle | Imran Iqbal Abderrahim Oulhaj Javaid Nauman Salem Alkaabi Asma Alnuaimi Mariam Alharbi Mohammed A Amari Rajiv Ganapathy A clinical risk score to predict in-hospital mortality in critically ill patients with COVID-19: a retrospective cohort study BMJ Open |
| title | A clinical risk score to predict in-hospital mortality in critically ill patients with COVID-19: a retrospective cohort study |
| title_full | A clinical risk score to predict in-hospital mortality in critically ill patients with COVID-19: a retrospective cohort study |
| title_fullStr | A clinical risk score to predict in-hospital mortality in critically ill patients with COVID-19: a retrospective cohort study |
| title_full_unstemmed | A clinical risk score to predict in-hospital mortality in critically ill patients with COVID-19: a retrospective cohort study |
| title_short | A clinical risk score to predict in-hospital mortality in critically ill patients with COVID-19: a retrospective cohort study |
| title_sort | clinical risk score to predict in hospital mortality in critically ill patients with covid 19 a retrospective cohort study |
| url | https://bmjopen.bmj.com/content/11/8/e048770.full |
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