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Shibata Y, Omae K, Minemura H, Suzuki Y, Nikaido T, Tanino Y, Fukuhara A, Kanno R, Saito H, Suzuki S, Ishii T, Inokoshi Y, Sando E, Sakuma H, Kobayashi T, Kume H, Kamimoto M, Aoki H, Takama A, Kamiyama T, Nakayama M, Saito K, Tanigawa K, Sato M, Kambe T, Kanzaki N, Azuma T, Sakamoto K, Nakamura Y, Ohtani H, Waragai M, Maeda S, Ishida T, Sugino K, Inage M, Hirama N, Furuyama K, Fukushima S, Saito H, Machiya JI, Machida H, Abe K, Iwabuchi K, Katagiri Y, Aida Y, Abe Y, Ota T, Ishizawa Y, Tsukada Y, Yamada R, Sato R, Onuma T, Tomita H, Saito M, Watanabe N, Rikimaru M, Kawamata T, Umeda T, Morimoto J, Togawa R, Sato Y, Saito J, Kanazawa K, Kurita N, Iseki K. Development and external validation of the DOAT and DOATS scores: simple decision support tools to identify disease progression among nonelderly patients with mild/moderate COVID-19. BMC Pulm Med 2023; 23:312. [PMID: 37641057 PMCID: PMC10463653 DOI: 10.1186/s12890-023-02604-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/10/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND During the fifth wave of the coronavirus disease 2019 (COVID-19) pandemic in Japan, which took place between June and September 2021, a significant number of COVID-19 cases with deterioration occurred in unvaccinated individuals < 65 years old. However, the risk factors for COVID-19 deterioration in this specific population have not yet been determined. This study developed a prediction method to identify COVID-19 patients < 65 years old who are at a high risk of deterioration. METHODS This retrospective study analyzed data from 1,675 patients < 65 years old who were admitted to acute care institutions in Fukushima with mild-to-moderate-1 COVID-19 based on the Japanese disease severity criteria prior to the fifth wave. For validation, 324 similar patients were enrolled from 3 hospitals in Yamagata. Logistic regression analyses using cluster-robust variance estimation were used to determine predictors of disease deterioration, followed by creation of risk prediction scores. Disease deterioration was defined as the initiation of medication for COVID-19, oxygen inhalation, or mechanical ventilation starting one day or later after admission. RESULTS The patients whose condition deteriorated (8.6%) tended to be older, male, have histories of smoking, and have high body temperatures, low oxygen saturation values, and comorbidities, such as diabetes/obesity and hypertension. Stepwise variable selection using logistic regression to predict COVID-19 deterioration retained comorbidities of diabetes/obesity (DO), age (A), body temperature (T), and oxygen saturation (S). Two predictive scores were created based on the optimism-corrected regression coefficients: the DOATS score, including all of the above risk factors, and the DOAT score, which was the DOATS score without oxygen saturation. In the original cohort, the areas under the receiver operating characteristic curve (AUROCs) of the DOATS and DOAT scores were 0.81 (95% confidence interval [CI] 0.77-0.85) and 0.80 (95% CI 0.76-0.84), respectively. In the validation cohort, the AUROCs for each score were both 0.76 (95% CI 0.69-0.83), and the calibration slopes were both 0.80. A decision curve analysis confirmed the clinical practicability of both scores in the validation cohort. CONCLUSIONS We established two prediction scores that can quickly evaluate the risk of COVID-19 deterioration in mild/moderate patients < 65 years old.
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Affiliation(s)
- Yoko Shibata
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kenji Omae
- Department of Innovative Research and Education for Clinicians and Trainees, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuhito Suzuki
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takefumi Nikaido
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Pulmonary Medicine, Ohara General Hospital, Fukushima, Japan
| | - Yoshinori Tanino
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Atsuro Fukuhara
- Department of Pulmonary Medicine, Ohara General Hospital, Fukushima, Japan
| | - Ryuzo Kanno
- Department of Thoracic Surgery, Fukushima Red Cross Hospital, Fukushima, Japan
| | - Hiroyuki Saito
- Department of Internal Medicine, Fujita General Hospital, Date-gun, Japan
| | - Shuzo Suzuki
- Department of Internal Medicine, Fujita General Hospital, Date-gun, Japan
| | - Taeko Ishii
- Department of Pulmonary Medicine, Saiseikai Fukushima General Hospital, Fukushima, Japan
| | - Yayoi Inokoshi
- Department of Pulmonary Medicine, Saiseikai Fukushima General Hospital, Fukushima, Japan
| | - Eiichiro Sando
- Department of General Internal Medicine and Clinical Infectious Diseases, Fukushima Medical University, Fukushima, Japan
- Department of General Internal Medicine and Infectious Diseases, Kita-Fukushima Medical Center, Date-shi, Japan
| | - Hirofumi Sakuma
- Department of Internal Medicine, Saiseikai Kawamata Hospital, Kawamata, Japan
| | - Tatsuho Kobayashi
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizuwakamatsu, Japan
| | - Hiroaki Kume
- Department of Infectious Disease and Pulmonary Medicine, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Masahiro Kamimoto
- Department of Internal Medicine, Takeda General Hospital, Aizuwakamatsu, Japan
| | - Hideko Aoki
- Department of Pediatric Medicine, Bange Kousei General Hospital, Kawanuma, Japan
| | - Akira Takama
- Department of Surgery, Yurin Hospital, Kitakata, Japan
| | - Takamichi Kamiyama
- Department of Pediatric Surgery, Iwaki City Medical Center, Iwaki, Japan
| | - Masaru Nakayama
- Department of Internal Medicine, Kashima Hospital, Iwaki, Japan
| | - Kiyoshi Saito
- Department of Neurosurgery, Fukushima Rosai Hospital, Iwaki, Japan
| | - Koichi Tanigawa
- Department of Emergency and Critical Care Medicine, Futaba Medical Center, Futaba, Japan
| | - Masahiko Sato
- Department of Internal Medicine, Soma General Hospital, Soma, Japan
| | - Toshiyuki Kambe
- Department of Pulmonary Medicine, Minami-Soma Municipal General Hospital, Minami-Soma, Japan
| | - Norio Kanzaki
- Department of Surgery, Onahama Chuo Clinic, Iwaki, Japan
| | - Teruhisa Azuma
- Department of General Medicine, Shirakawa Satellite for Teaching and Research, Fukushima Medical University, Shirakawa, Japan
| | - Keiji Sakamoto
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, Koriyama, Japan
| | - Yuichi Nakamura
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, Koriyama, Japan
| | - Hiroshi Ohtani
- Department of Internal Medicine, Iwase General Hospital, Sukagawa, Japan
| | - Mitsuru Waragai
- Department of Surgery, Southern TOHOKU General Hospital, Koriyama, Japan
| | - Shinsaku Maeda
- Department of Pulmonary Medicine, Jusendo General Hospital, Koriyama, Japan
| | - Tokiya Ishida
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Keishi Sugino
- Department of Respiratory Medicine, Tsuboi Hospital, Koriyama, Japan
| | - Minoru Inage
- Department of Pulmonary Medicine, Okitama General Hospital, Higashi-Okitama, Japan
| | - Noriyuki Hirama
- Department of Pulmonary Medicine, Okitama General Hospital, Higashi-Okitama, Japan
| | - Kodai Furuyama
- Department of Pulmonary Medicine, Okitama General Hospital, Higashi-Okitama, Japan
| | - Shigeyuki Fukushima
- Department of Pulmonary Medicine, Okitama General Hospital, Higashi-Okitama, Japan
| | - Hiroshi Saito
- Department of Pulmonary Medicine, Nihonkai General Hospital, Sakata, Japan
| | - Jun-Ichi Machiya
- Department of Pulmonary Medicine, Nihonkai General Hospital, Sakata, Japan
| | - Hiroyoshi Machida
- Department of Pulmonary Medicine, Nihonkai General Hospital, Sakata, Japan
| | - Koya Abe
- Department of Pulmonary Medicine, Nihonkai General Hospital, Sakata, Japan
| | - Katsuyoshi Iwabuchi
- Department of Pulmonary Medicine, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Yuji Katagiri
- Department of Pulmonary Medicine, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Yasuko Aida
- Department of Pulmonary Medicine, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Yuki Abe
- Department of Pulmonary Medicine, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Takahito Ota
- Department of Pulmonary Medicine, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Yuki Ishizawa
- Department of Pulmonary Medicine, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Yasuhiko Tsukada
- Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima, Japan
| | - Ryuki Yamada
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Riko Sato
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takumi Onuma
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hikaru Tomita
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mikako Saito
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Natsumi Watanabe
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mami Rikimaru
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takaya Kawamata
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takashi Umeda
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Julia Morimoto
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Ryuichi Togawa
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yuki Sato
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Junpei Saito
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kenya Kanazawa
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Noriaki Kurita
- Department of Innovative Research and Education for Clinicians and Trainees, Fukushima Medical University Hospital, Fukushima, Japan
| | - Ken Iseki
- Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima, Japan
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Zinellu A, Mangoni AA. A systematic review and meta-analysis of the association between the neutrophil, lymphocyte, and platelet count, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio and COVID-19 progression and mortality. Expert Rev Clin Immunol 2022; 18:1187-1202. [PMID: 36047369 DOI: 10.1080/1744666x.2022.2120472] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Severe manifestations of coronavirus disease 2019 (COVID-19) are associated with alterations in blood cells that regulate immunity, inflammation, and hemostasis. We conducted an updated systematic review and meta-analysis of the association between the neutrophil, lymphocyte, and platelet count, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), and COVID-19 progression and mortality. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published between January 2020 and June 2022. RESULTS In 71 studies reporting the investigated parameters within 48 hours of admission, higher NLR (HR 1.21, 95% CI 1.16 to 1.27, p < 0.0001), relative neutrophilia (HR 1.62, 95% CI 1.46 to 1.80, p < 0.0001), relative lymphopenia (HR 1.62, 95% CI 1.27 to 2.08, p < 0.001), and relative thrombocytopenia (HR 1.74, 95% CI 1.36 to 2.22, p < 0.001), but not PLR (p = 0.11), were significantly associated with disease progression and mortality. Between-study heterogeneity was large-to-extreme. The magnitude and direction of the effect size were not modified in sensitivity analysis. CONCLUSIONS NLR and neutrophil, lymphocyte, and platelet count significantly discriminate COVID-19 patients with different progression and survival outcomes. (PROSPERO registration number: CRD42021267875).
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
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