Development and validation of a prognostic model for early triage of patients diagnosed with COVID-19

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作者
Chansik An
Hyun Cheol Oh
Jung Hyun Chang
Seung-Jin Oh
Jung Mo Lee
Chang Hoon Han
Seong Woo Kim
机构
[1] National Health Insurance Service Ilsan Hospital,Research Institute
[2] National Health Insurance Service Ilsan Hospital,Department of Radiology
[3] National Health Insurance Service Ilsan Hospital,Department of Orthopedic Surgery
[4] National Health Insurance Service Ilsan Hospital,Department of Otolaryngology
[5] National Health Insurance Service Ilsan Hospital,Head and Neck Surgery
[6] National Health Insurance Service Ilsan Hospital,Division of Cardiology, Department of Internal Medicine
[7] National Health Insurance Service Ilsan Hospital,Division of Pulmonology, Department of Internal Medicine
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We developed a tool to guide decision-making for early triage of COVID-19 patients based on a predicted prognosis, using a Korean national cohort of 5,596 patients, and validated the developed tool with an external cohort of 445 patients treated in a single institution. Predictors chosen for our model were older age, male sex, subjective fever, dyspnea, altered consciousness, temperature ≥ 37.5 °C, heart rate ≥ 100 bpm, systolic blood pressure ≥ 160 mmHg, diabetes mellitus, heart disease, chronic kidney disease, cancer, dementia, anemia, leukocytosis, lymphocytopenia, and thrombocytopenia. In the external validation, when age, sex, symptoms, and underlying disease were used as predictors, the AUC used as an evaluation metric for our model’s performance was 0.850 in predicting whether a patient will require at least oxygen therapy and 0.833 in predicting whether a patient will need critical care or die from COVID-19. The AUCs improved to 0.871 and 0.864, respectively, when additional information on vital signs and blood test results were also used. In contrast, the protocols currently recommended in Korea showed AUCs less than 0.75. An application for calculating the prognostic score in COVID-19 patients based on the results of this study is presented on our website (https://nhimc.shinyapps.io/ih-psc/), where the results of the validation ongoing in our institution are periodically updated.
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