Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar;36(3):730-737.
doi: 10.1007/s11606-020-06353-5. Epub 2020 Dec 3.

Derivation of a Clinical Risk Score to Predict 14-Day Occurrence of Hypoxia, ICU Admission, and Death Among Patients with Coronavirus Disease 2019

David M Levine  1   2 , Stuart R Lipsitz  3   4 , Zoe Co  3 , Wenyu Song  3   4 , Patricia C Dykes  3   4 , Lipika Samal  3   4
Affiliations

Derivation of a Clinical Risk Score to Predict 14-Day Occurrence of Hypoxia, ICU Admission, and Death Among Patients with Coronavirus Disease 2019

David M Levine et al. J Gen Intern Med. 2021 Mar.

Abstract

Background: Uncertainty surrounding COVID-19 regarding rapid progression to acute respiratory distress syndrome and unusual clinical characteristics make discharge from a monitored setting challenging. A clinical risk score to predict 14-day occurrence of hypoxia, ICU admission, and death is unavailable.

Objective: Derive and validate a risk score to predict suitability for discharge from a monitored setting among an early cohort of patients with COVID-19.

Design: Model derivation and validation in a retrospective cohort. We built a manual forward stepwise logistic regression model to identify variables associated with suitability for discharge and assigned points to each variable. Event-free patients were included after at least 14 days of follow-up.

Participants: All adult patients with a COVID-19 diagnosis between March 1, 2020, and April 12, 2020, in 10 hospitals in Massachusetts, USA.

Main measures: Fourteen-day composite predicting hypoxia, ICU admission, and death. We calculated a risk score for each patient as a predictor of suitability for discharge evaluated by area under the curve.

Key results: Of 2059 patients with COVID-19, 1326 met inclusion. The 1014-patient training cohort had a mean age of 58 years, was 56% female, and 65% had at least one comorbidity. A total of 255 (25%) patients were suitable for discharge. Variables associated with suitability for discharge were age, oxygen saturation, and albumin level, yielding a risk score between 0 and 55. At a cut point of 30, the score had a sensitivity of 83% and specificity of 82%. The respective c-statistic for the derivation and validation cohorts were 0.8939 (95% CI, 0.8687 to 0.9192) and 0.8685 (95% CI, 0.8095 to 0.9275). The score performed similarly for inpatients and emergency department patients.

Conclusions: A 3-item risk score for patients with COVID-19 consisting of age, oxygen saturation, and an acute phase reactant (albumin) using point of care data predicts suitability for discharge and may optimize scarce resources.

Keywords: COVID-19; patient discharge; prognosis; risk score; severe acute respiratory syndrome coronavirus 2.

PubMed Disclaimer

Conflict of interest statement

Zoe Co: None

Patricia C Dykes: None

David M Levine: Dr. Levine reports receiving funds from Biofourmis for a PI-initiated study regarding home hospital patients, separate from the present work.

Stuart R Lipsitz: None

Lipika Samal: None

Wenyu Song: None

Figures

Figure 1
Figure 1
Sample selection schematic. COVID-19, coronavirus disease 2019.
Figure 2
Figure 2
Risk score tool for the point of care.
See this image and copyright information in PMC

Comment in

  • Clinical Risk Score and COVID-19.
    Mungmunpuntipantip R, Wiwanitkit V. Mungmunpuntipantip R, et al. J Gen Intern Med. 2021 Jul;36(7):2151. doi: 10.1007/s11606-021-06721-9. Epub 2021 Apr 5. J Gen Intern Med. 2021. PMID: 33821409 Free PMC article. No abstract available.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. WHO COVID-19 Dashboard. Published 2020. Accessed Aug 13, 2020. https://who.sprinklr.com/.
    1. COVID-19 Projections. Published 2020. Accessed Aug 13, 2020. https://covid19.healthdata.org/united-states-of-america.
    1. Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. Published online February 28, 2020;NEJMoa2002032. 10.1056/NEJMoa2002032. - PMC - PubMed
    1. Mo P, Xing Y, Xiao Y, et al. Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. Clin Infect Dis. Published online March 16, 2020. 10.1093/cid/ciaa270. - PubMed
    1. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. Published online February 24, 2020. 10.1001/jama.2020.2648. - PubMed

Publication types