Development and Validation of a Web Based Severe COVID 19 Risk Prediction Model
Background: Coronavirus disease 2019 (COVID 19) carries high morbidity and mortality globally. Identification of patients at risk for clinical deterioration upon presentation would aid in triaging, prognostication, and allocation of resources and experimental treatments. Research Question: Can we develop and validate a web based risk prediction model for identification of patients who may develop severe COVID 19, defined as intensive care unit (ICU) admission, mechanical ventilation, and/or death? Methods: This retrospective cohort study reviewed 415 patients admitted to a large urban academic medical center and community hospitals. Covariates included demographic, clinical, and laboratory data. The independent association of predictors with severe COVID 19 was determined using multivariable logistic regression. A derivation cohort (n=311, 75% was used to develop the prediction models. The models were tested by a validation cohort (n=104, 25% Results: The median age was 66 years (Interquartile range [IQR] 54 77) and the majority were male (55% and non White (65.8% The 14 day severe COVID 19 rate was 39.3% 31.7% required ICU, 24.6% mechanical ventilation, and 21.2% died. Machine learning algorithms and clinical judgment were used to improve model performance and clinical utility, resulting in the selection of eight predictors: age, sex, dyspnea, diabetes mellitus, troponin, C reactive protein, D dimer, and aspartate aminotransferase. The discriminative ability was excellent for both the severe COVID 19 (training area under the curve [AUC]=0.82, validation AUC=0.82) and mortality (training AUC= 0.85, validation AUC=0.81) models. These models were incorporated into a mobile friendly website. Interpretation: This web based risk prediction model can be used at the bedside for prediction of severe COVID 19 using data mostly available at the time of presentation.
The American Journal of the Medical Sciences