Wednesday, 4 August 2021

Miguel Martinez-Lacalzada, Adrián Viteri-Noël, Luis Manzano, Martin Fabregate, et al. Predicting critical illness on initial diagnosis of COVID-19 based on easily-obtained clinical variables: development and validation of the PRIORITY model

Clin Microbiol Infect. 2021

"The study could provide underpinning evidence to inform decision-making in health systems under pandemic pressure." - Dr. Luis Manzano et al -.

Summary:

Objectives: We aimed to develop and validate a prediction model, based on clinical history and examination findings on initial diagnosis of COVID-19, to identify patients at risk of critical outcomes.

Methods: We used data from the SEMI-COVID-19 Registry, a cohort of consecutive patients hospitalized for COVID-19 from 132 centers in Spain (23 March to 21 May, 2020). For the development cohort tertiary referral hospitals were selected, while the validation cohort included smaller hospitals. The primary outcome was a composite of in-hospital death, mechanical ventilation or admission to intensive care unit. Clinical signs and symptoms, demographics, and medical history ascertained at presentation were screened using least absolute shrinkage and selection operator, and logistic regression was used to construct the predictive model.

Results: There were 10,433 patients, 7,850 in the development cohort (primary outcome 25.1%, 1,967/7,850) and 2,583 in the validation cohort (outcome 27.0%, 698/2,583). The PRIORITY model included: age, dependency, cardiovascular disease, chronic kidney disease, dyspnoea, tachypnoea, confusion, systolic blood pressure, and SpO2≤93% or oxygen requirement. The model showed high discrimination for critical illness in both the development (C-statistic 0.823; 95% confidence interval [CI] 0.813, 0.834) and validation (C-statistic 0.794; 95% CI 0.775, 0.813) cohorts. A freely available web-based calculator was developed based on this model (https://www.evidencio.com/models/show/2344).

Conclusions: The PRIORITY model, based on easily-obtained clinical information, had good discrimination and generalizability for identifying COVID-19 patients at risk of critical outcomes.

Why do you highlight this publication?

The PRIORITY model was developed and validated in a national multicenter cohort to estimate the risk of COVID-19 critical illness using nine clinical variables easily measurable in resource-limited or out-of-hospital settings.

The model showed good performance and generalizability for risk assessment of COVID-19 critical outcomes at initial presentation.

The easy-to-use model-based online calculator could help triage outpatients on initial diagnosis, optimizing the use of stretched healthcare resources during pandemic peak.