Development and validation of a prediction model for estimating one-month mortality of adult COVID-19 patients presenting at emergency department with suspected pneumonia: a multicenter analysis

• Published in: Internal and emergency medicine 2022-04, Vol.17 (3), p.805-814
• Main Authors: Chou, Eric H., Wang, Chih-Hung, Chou, Fan-Ya, Tsai, Chu-Lin, Wolfshohl, Jon, Garrett, John, Bhakta, Toral, Shedd, Andrew, Hassani, Dahlia, Risch, Robert, d’Etienne, James, Ogola, Gerald O., Lu, Tsung-Chien, Ma, Matthew Huei-Ming
• Format: Article
• Language: English
• Subjects: Adult; Body mass index; Congestive heart failure; Coronary artery disease; Coronaviruses; COVID-19; COVID-19 : diagnosis; Decision making; Emergency medical care; Emergency Service, Hospital; Hepatitis; Humans; Im - Original; Internal Medicine; Kidney diseases; L-Lactate dehydrogenase; Lactic acid; Leukocytes (neutrophilic); Lymphocytes; management and prognosis; Medicine; Medicine & Public Health; Mortality; Patients; Pneumonia; Pneumonia - diagnosis; Prediction models; Renal failure; Retrospective Studies; ROC Curve; SARS-CoV-2; Vital signs
• ISSN: 1828-0447; 1970-9366
• DOI: 10.1007/s11739-021-02882-x

There are only a few models developed for risk-stratifying COVID-19 patients with suspected pneumonia in the emergency department (ED). We aimed to develop and validate a model, the COVID-19 ED pneumonia mortality index (CoV-ED-PMI), for predicting mortality in this population. We retrospectively included adult COVID-19 patients who visited EDs of five study hospitals in Texas and who were diagnosed with suspected pneumonia between March and November 2020. The primary outcome was 1-month mortality after the index ED visit. In the derivation cohort, multivariable logistic regression was used to develop the CoV-ED-PMI model. In the chronologically split validation cohort, the discriminative performance of the CoV-ED-PMI was assessed by the area under the receiver operating characteristic curve (AUC) and compared with other existing models. A total of 1678 adult ED records were included for analysis. Of them, 180 patients sustained 1-month mortality. There were 1174 and 504 patients in the derivation and validation cohorts, respectively. Age, body mass index, chronic kidney disease, congestive heart failure, hepatitis, history of transplant, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, and national early warning score were included in the CoV-ED-PMI. The model was validated with good discriminative performance (AUC: 0.83, 95% confidence interval [CI]: 0.79–0.87), which was significantly better than the CURB-65 (AUC: 0.74, 95% CI: 0.69–0.79, p -value: