Development and validation of prognostic model for predicting mortality of COVID-19 patients in Wuhan, China

被引:6
|
作者
Mei, Qi [1 ]
Wang, Amanda Y. [2 ,3 ,4 ]
Bryant, Amy [5 ]
Yang, Yang [6 ]
Li, Ming [7 ]
Wang, Fei [8 ]
Zhao, Jia Wei [9 ]
Ma, Ke [10 ]
Wu, Liang [10 ]
Chen, Huawen [11 ]
Luo, Jinlong [11 ]
Du, Shangming [12 ]
Halfter, Kathrin [12 ]
Li, Yong [13 ]
Kurts, Christian [14 ]
Hu, Guangyuan [1 ]
Yuan, Xianglin [1 ]
Li, Jian [14 ]
机构
[1] Huazhong Univ Sci & Technol, Tongji Hosp, Tongji Med Coll, Wuhan, Hubei, Peoples R China
[2] Univ New South Wales, George Inst Global Hlth, Renal & Metab Div, Sydney, NSW, Australia
[3] Univ Sydney, Concord Clin Sch, Sydney, NSW, Australia
[4] Concord Repatriat Gen Hosp, Dept Renal Med, Concord, Australia
[5] Idaho State Univ, Dept Biomed & Pharmaceut Sci, Coll Pharm, Meridian, ID USA
[6] Wuhan Univ, Renmin Hosp, Wuhan, Hubei, Peoples R China
[7] Wuhan Pulm Hosp, Dept Resp & Crit Care Med, Wuhan, Hubei, Peoples R China
[8] Huazhong Univ Sci & Technol, Wuhan 1 Hosp, Dept Chinese Med, Tongji Med Coll, Wuhan, Hubei, Peoples R China
[9] Univ Sydney, Fac Pharm, Sydney, NSW, Australia
[10] Huazhong Univ Sci & Technol, Dept & Inst Infect Dis, Tongji Hosp, Tongji Med Coll, Wuhan, Hubei, Peoples R China
[11] Huazhong Univ Sci & Technol, Tongji Hosp, Tongji Med Coll, Dept Emergency Med, Wuhan, Hubei, Peoples R China
[12] Ludwig Maximilians Univ Munchen, Inst Med Informat Biometry & Epidemiol, Munich, Germany
[13] Huazhong Univ Sci & Technol, Dept Resp & Crit Care Med, Natl Clin Res Ctr Resp Dis, Tongji Hosp,Tongji Med Coll, Wuhan, Hubei, Peoples R China
[14] Rheinische Friedrich Wilhelms Univ, Inst Expt Immunol, Bonn, Germany
基金
中国国家自然科学基金;
关键词
ASPARTATE; CANCER; ALANINE;
D O I
10.1038/s41598-020-78870-6
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Novel coronavirus 2019 (COVID-19) infection is a global public health issue, that has now affected more than 200 countries worldwide and caused a second wave of pandemic. Severe adult respiratory syndrome-CoV-2 (SARS-CoV-2) pneumonia is associated with a high risk of mortality. However, prognostic factors predicting poor clinical outcomes of individual patients with SARS-CoV-2 pneumonia remain under intensive investigation. We conducted a retrospective, multicenter study of patients with SARS-CoV-2 who were admitted to four hospitals in Wuhan, China from December 2019 to February 2020. Mortality at the end of the follow up period was the primary outcome. Factors predicting mortality were also assessed and a prognostic model was developed, calibrated and validated. The study included 492 patients with SARS-CoV-2 who were divided into three cohorts: the training cohort (n=237), the validation cohort 1 (n=120), and the validation cohort 2 (n=135). Multivariate analysis showed that five clinical parameters were predictive of mortality at the end of follow up period, including advanced age [odds ratio (OR), 1.1/years increase (p<0.001)], increased neutrophil-to-lymphocyte ratio [(NLR) OR, 1.14/increase (p<0.001)], elevated body temperature on admission [OR, 1.53/degrees C increase (p=0.005)], increased aspartate transaminase [OR, 2.47 (p=0.019)], and decreased total protein [OR, 1.69 (p=0.018)]. Furthermore, the prognostic model drawn from the training cohort was validated with validation cohorts 1 and 2 with comparable area under curves (AUC) at 0.912, 0.928, and 0.883, respectively. While individual survival probabilities were assessed, the model yielded a Harrell's C index of 0.758 for the training cohort, 0.762 for the validation cohort 1, and 0.711 for the validation cohort 2, which were comparable among each other. A validated prognostic model was developed to assist in determining the clinical prognosis for SARS-CoV-2 pneumonia. Using this established model, individual patients categorized in the high risk group were associated with an increased risk of mortality, whereas patients predicted to be in the low risk group had a higher probability of survival.
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页数:12
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