A nomogram to predict the risk of unfavourable outcome in COVID-19: a retrospective cohort of 279 hospitalized patients in Paris area

Link to article at PubMed

Ann Med. 2020 Jul 29:1-23. doi: 10.1080/07853890.2020.1803499. Online ahead of print.


Objective. To identify predictive factors of unfavourable outcome among patients hospitalized for COVID-19.Methods. We conducted a monocentric retrospective cohort study ofCOVID-19 patients hospitalized in Paris area. An unfavourable outcome was defined as the need for artificial ventilation and/or death. Characteristics at admission were analysed to identify factors predictive of unfavourableoutcome using multivariable Cox proportional hazard models. Based on the results, anomogram to predict 14-day probability ofpooroutcome was proposed.Results. Between March 15th and April 14th, 2020, 279 COVID-19 patients were hospitalized after a median of 7 days after the first symptoms. Among them, 88 (31.5%) patients had an unfavourable outcome:48 were admitted tothe ICU for artificial ventilation, and 40 patients died without being admitted to ICU. Multivariable analyses retained age, overweight, polypnoea, fever, high C-reactive protein, elevatedus troponin-I, and lymphopenia as risk factors ofan unfavourable outcome. A nomogram was established with sufficient discriminatory power (C-index 0.75), and proper consistence between the prediction and the observation.Conclusion. We identified seven easily available prognostic factors and proposed a simplenomogram for early detection of patients at risk of aggravation,inorder to optimize clinical care and initiate specific therapies. Key MessagesSince novel coronavirus disease 2019 pandemic, a minority of patients develops severe respiratory distress syndrome, leading to death despite intensive care. Tools to identify patients at risk in European populations are lacking.In our series, age, respiratory rate, overweight, temperature, C-reactive protein, troponin and lymphocyte counts were risk factors of an unfavourable outcome in hospitalized adult patients.We propose an easy-to-use nomogram to predict unfavourable outcome for hospitalized adult patients to optimize clinical care and initiate specific therapies.

PMID:32723107 | DOI:10.1080/07853890.2020.1803499

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