Development and validation of a prognostic model based on comorbidities to predict COVID-19 severity: a population-based study

• Published in: International journal of epidemiology 2021-03, Vol.50 (1), p.64-74
• Main Authors: Gude-Sampedro, Francisco, Fernández-Merino, Carmen, Ferreiro, Lucía, Lado-Baleato, Óscar, Espasandín-Domínguez, Jenifer, Hervada, Xurxo, Cadarso, Carmen M, Valdés, Luis
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Area Under Curve; Comorbidity; Covid-19; COVID-19 - diagnosis; COVID-19 - mortality; Critical Care - statistics & numerical data; Female; Hospital Mortality; Humans; Intensive Care Units - statistics & numerical data; Male; Middle Aged; Patient Admission - statistics & numerical data; Predictive Value of Tests; Prognosis; Reproducibility of Results; Retrospective Studies; Risk Factors; SARS-CoV-2; Severity of Illness Index; Spain - epidemiology
• ISSN: 0300-5771; 1464-3685
• DOI: 10.1093/ije/dyaa209

Abstract Background The prognosis of patients with COVID-19 infection is uncertain. We derived and validated a new risk model for predicting progression to disease severity, hospitalization, admission to intensive care unit (ICU) and mortality in patients with COVID-19 infection (Gal-COVID-19 scores). Methods This is a retrospective cohort study of patients with COVID-19 infection confirmed by reverse transcription polymerase chain reaction (RT-PCR) in Galicia, Spain. Data were extracted from electronic health records of patients, including age, sex and comorbidities according to International Classification of Primary Care codes (ICPC-2). Logistic regression models were used to estimate the probability of disease severity. Calibration and discrimination were evaluated to assess model performance. Results The incidence of infection was 0.39% (10 454 patients). A total of 2492 patients (23.8%) required hospitalization, 284 (2.7%) were admitted to the ICU and 544 (5.2%) died. The variables included in the models to predict severity included age, gender and chronic comorbidities such as cardiovascular disease, diabetes, obesity, hypertension, chronic obstructive pulmonary disease, asthma, liver disease, chronic kidney disease and haematological cancer. The models demonstrated a fair–good fit for predicting hospitalization {AUC [area under the receiver operating characteristics (ROC) curve] 0.77 [95% confidence interval (CI) 0.76, 0.78]}, admission to ICU [AUC 0.83 (95%CI 0.81, 0.85)] and death [AUC 0.89 (95%CI 0.88, 0.90)]. Conclusions The Gal-COVID-19 scores provide risk estimates for predicting severity in COVID-19 patients. The ability to predict disease severity may help clinicians prioritize high-risk patients and facilitate the decision making of health authorities.