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. 2021 Nov;53(9):102118.
doi: 10.1016/j.aprim.2021.102118. Epub 2021 May 28.

Development of a predictive prognostic rule for early assessment of COVID-19 patients in primary care settings

Angel Vila-Corcoles  1 , Eva Satue-Gracia  1 , Angel Vila-Rovira  2 , Cinta de Diego-Cabanes  3 , Maria Jose Forcadell-Peris  3 , Olga Ochoa-Gondar  4
Affiliations

Development of a predictive prognostic rule for early assessment of COVID-19 patients in primary care settings

Angel Vila-Corcoles et al. Aten Primaria. 2021 Nov.

Abstract
in English, Spanish

Objective: To investigate possible early prognostic factors among middle-aged and older adult and explore prognostic rules stratifying risk of patients.

Design: Community-based retrospective cohort.

Setting: Primary Health Care Tarragona region.

Participants: 282 community-dwelling symptomatic patients ≥50 years with laboratory-confirmed COVID-19 (hospitalised and/or outpatient) during March-June 2020 in Tarragona (Southern Catalonia, Spain).

Main outcome measurements: Relationship between demographics, pre-existing comorbidities and early symptomatology (first 5-days) and risk of suffering critical outcome (ICU-admission/death) across clinical course was evaluated by logistic regression analyses, and simple predictive models were developed.

Results: Of the 282 cases (mean age: 65.9 years; 140 men), 154 (54.6%) were hospitalised (30 ICU-admitted) and 45 (16%) deceased. Median time follow-up in clinical course was 31 days (range: 30-150) for survivors and 14 days (range: 1-81) for deceased patients. In crude analyses, increasing age, male sex, some comorbidities (renal, respiratory or cardiac disease, diabetes and hypertension) and symptoms (confusion, dyspnoea) were associated with an increased risk to suffer critical outcome, whereas other symptoms (rinorrhea, myalgias, headache, anosmia/disgeusia) were related with reduced risk. After multivariable-adjustment only age/years (OR: 1.04; 95% CI: 1.01-1.07; p=0.004), confusion (OR: 5.33; 95% CI: 1.54-18.48; p=0.008), dyspnoea (OR: 5.41; 95% CI: 2.74-10.69; p<0.001) and myalgias (OR: 0.30; 95% CI: 0.10-0.93; p=0.038) remained significantly associated with increased or reduced risk. A proposed CD65-M prognostic rule (acronym of above mentioned 4 variables) showed a good correlation with the risk of suffering critical outcome (area under ROC curve: 0.828; 95% CI: 0.774-0.882).

Conclusion: Clinical course of COVID-19 is early unpredictable, but simple clinical tools as the proposed CD65-M rule (pending external validation) may be helpful assessing these patients in primary care settings.

Objetivo: Investigar posibles factores pronósticos y escalas predictivas simples en adultos mayores con COVID-19.

Diseño: Cohorte retrospectiva de base comunitaria.

Emplazamiento: Atención Primaria Tarragona.

Participantes: 282 adultos ≥ 50 años no institucionalizados con COVID-19 confirmada (hospitalizada o ambulatoria) ocurrida durante marzo-junio de 2020.

Mediciones principales: La relación entre covariables basales (edad, sexo, condiciones/comorbilidades preexistentes y sintomatología inicial) y el riesgo de mala evolución (ingreso en UCI o muerte) se analizó mediante modelos de regresión logística.

Resultados: De los 282 casos de COVID-19 (edad media 65,9 años; 49,6% varones), 154 (54,6%) fueron hospitalizados (30 ingresados en UCI) y 45 (16%) fallecieron. En total, 64 (22,7%) requirieron UCI o fallecieron. La mediana de tiempo de seguimiento durante el curso clínico fue de 31 días (rango: 30-150) en los pacientes que sobrevivieron y de 14 días (rango: 1-81) en fallecidos. En análisis crudos, la edad/años, sexo varón, algunas comorbilidades (enfermedad renal, respiratoria o cardiaca, diabetes e hipertensión) y síntomas (confusión/letargia, disnea) se asociaron con mayor riesgo de UCI/muerte, mientras que otros síntomas (rinorrea, mialgias, cefalea, ageusia/anosmia) se asociaron con menor riesgo. En análisis multivariable solo la edad/años (OR: 1,04; IC 95%: 1,01-1,07; p = 0,004), confusión/letargia (OR: 5,33; IC 95%: 1,54-18,48; p = 0,008), disnea (OR: 5,41; IC 95%: 2,74-10,69; p < 0,001) y mialgias (OR: 0,30; IC 95%: 0,10-0,93; p = 0,038) permanecieron significativamente asociadas con mayor/menor riesgo. Una posible escala pronóstica CD65-M (acrónimo de las 4 variables mencionadas) mostró buena correlación con el riesgo de UCI/muerte (área bajo la curva ROC: 0,828; IC 95%: 0,774-0,882).

Conclusión: La evolución clínica en pacientes COVID-19 es inicialmente impredecible, pero la aplicación de escalas pronósticas simples como la propuesta CD65-M (pendiente de validación externa) podría ser útil para una orientación/valoración pronóstica de estos pacientes en atención primaria.

Keywords: COVID-19; Comorbidities; Comorbilidades; Mortalidad; Mortality; Prognosis; Pronóstico; Symptoms; Síntomas.

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Figures

Figure 1
Figure 1
Comparison of ROC curves for both simple CD65-M and longer CD65RD-WMA rules.
See this image and copyright information in PMC

Comment in

  • [COVID-19 prognostic indicators in Primary Care].
    Satué Gracia EM, Vila Córcoles Á. Satué Gracia EM, et al. Aten Primaria. 2022 Jul;54(7):102308. doi: 10.1016/j.aprim.2022.102308. Epub 2022 Feb 10. Aten Primaria. 2022. PMID: 35306295 Free PMC article. Spanish. No abstract available.

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