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Berry DA, Ip A, Lewis BE, Berry SM, Berry NS, MrKulic M, Gadalla V, Sat B, Wright K, Serna M, Unawane R, Trpeski K, Koropsak M, Kaur P, Sica Z, McConnell A, Bednarz U, Marafelias M, Goy AH, Pecora AL, Sawczuk IS, Goldberg SL. Development and validation of a prognostic 40-day mortality risk model among hospitalized patients with COVID-19. PLoS One 2021; 16:e0255228. [PMID: 34329317 PMCID: PMC8323891 DOI: 10.1371/journal.pone.0255228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/12/2021] [Indexed: 12/23/2022] Open
Abstract
Objectives The development of a prognostic mortality risk model for hospitalized COVID-19 patients may facilitate patient treatment planning, comparisons of therapeutic strategies, and public health preparations. Methods We retrospectively reviewed the electronic health records of patients hospitalized within a 13-hospital New Jersey USA network between March 1, 2020 and April 22, 2020 with positive polymerase chain reaction results for SARS-CoV-2, with follow-up through May 29, 2020. With death or hospital discharge by day 40 as the primary endpoint, we used univariate followed by stepwise multivariate proportional hazard models to develop a risk score on one-half the data set, validated on the remainder, and converted the risk score into a patient-level predictive probability of 40-day mortality based on the combined dataset. Results The study population consisted of 3123 hospitalized COVID-19 patients; median age 63 years; 60% were men; 42% had >3 coexisting conditions. 713 (23%) patients died within 40 days of hospitalization for COVID-19. From 22 potential candidate factors 6 were found to be independent predictors of mortality and were included in the risk score model: age, respiratory rate ≥25/minute upon hospital presentation, oxygenation <94% on hospital presentation, and pre-hospital comorbidities of hypertension, coronary artery disease, or chronic renal disease. The risk score was highly prognostic of mortality in a training set and confirmatory set yielding in the combined dataset a hazard ratio of 1.80 (95% CI, 1.72, 1.87) for one unit increases. Using observed mortality within 20 equally sized bins of risk scores, a predictive model for an individual’s 40-day risk of mortality was generated as -14.258 + 13.460*RS + 1.585*(RS–2.524)^2–0.403*(RS–2.524)^3. An online calculator of this 40-day COVID-19 mortality risk score is available at www.HackensackMeridianHealth.org/CovidRS. Conclusions A risk score using six variables is able to prognosticate mortality within 40-days of hospitalization for COVID-19. Trial registration Clinicaltrials.gov Identifier: NCT04347993.
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Affiliation(s)
- Donald A. Berry
- Berry Consultants LLC, Austin, Texas, United States of America
- M.D. Anderson Cancer Center of the University of Texas, Houston, Texas, United States of America
| | - Andrew Ip
- Division of Outcomes and Value Research, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
- Hackensack Meridian Health School of Medicine, Nutley, New Jersey, United States of America
- * E-mail:
| | - Brett E. Lewis
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
- Hackensack Meridian Health School of Medicine, Nutley, New Jersey, United States of America
| | - Scott M. Berry
- Berry Consultants LLC, Austin, Texas, United States of America
| | | | - Mary MrKulic
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Virginia Gadalla
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Burcu Sat
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Kristen Wright
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Michelle Serna
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Rashmi Unawane
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Katerina Trpeski
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Michael Koropsak
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Puneet Kaur
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Zachary Sica
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Andrew McConnell
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Urszula Bednarz
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Michael Marafelias
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Andre H. Goy
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
- Hackensack Meridian Health School of Medicine, Nutley, New Jersey, United States of America
| | - Andrew L. Pecora
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
- Hackensack Meridian Health School of Medicine, Nutley, New Jersey, United States of America
| | - Ihor S. Sawczuk
- Hackensack Meridian Health School of Medicine, Nutley, New Jersey, United States of America
- Hackensack Meridian Health, Edison, New Jersey, United States of America
| | - Stuart L. Goldberg
- Division of Outcomes and Value Research, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
- Hackensack Meridian Health School of Medicine, Nutley, New Jersey, United States of America
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