Published in:
01-03-2022 | COVID-19 | Reports of Original Investigations
Development of a repeated-measures predictive model and clinical risk score for mortality in ventilated COVID-19 patients
Authors:
Justyna Bartoszko, MD, MSc, George Dranitsaris, MSc, PhD, M. Elizabeth Wilcox, MD, PhD, Lorenzo Del Sorbo, MD, Sangeeta Mehta, MD, Miki Peer, PhD, Matteo Parotto, MD, PhD, Isaac Bogoch, MD, MSc, Sheila Riazi, MD, MSc
Published in:
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
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Issue 3/2022
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Abstract
Purpose
The COVID-19 pandemic has caused intensive care units (ICUs) to reach capacities requiring triage. A tool to predict mortality risk in ventilated patients with COVID-19 could inform decision-making and resource allocation, and allow population-level comparisons across institutions.
Methods
This retrospective cohort study included all mechanically ventilated adults with COVID-19 admitted to three tertiary care ICUs in Toronto, Ontario, between 1 March 2020 and 15 December 2020. Generalized estimating equations were used to identify variables predictive of mortality. The primary outcome was the probability of death at three-day intervals from the time of ICU admission (day 0), with risk re-calculation every three days to day 15; the final risk calculation estimated the probability of death at day 15 and beyond. A numerical algorithm was developed from the final model coefficients.
Results
One hundred twenty-seven patients were eligible for inclusion. Median ICU length of stay was 26.9 (interquartile range, 15.4–52.0) days. Overall mortality was 42%. From day 0 to 15, the variables age, temperature, lactate level, ventilation tidal volume, and vasopressor use significantly predicted mortality. Our final clinical risk score had an area under the receiver-operating characteristics curve of 0.9 (95% confidence interval [CI], 0.8 to 0.9). For every ten-point increase in risk score, the relative increase in the odds of death was approximately 4, with an odds ratio of 4.1 (95% CI, 2.9 to 5.9).
Conclusion
Our dynamic prediction tool for mortality in ventilated patients with COVID-19 has excellent diagnostic properties. Notwithstanding, external validation is required before widespread implementation.