Association of the Intermountain Risk Score with major adverse health events in patients positive for COVID-19: an observational evaluation of a US cohort.

Autor:	Horne BD; Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA benjamin.horne@imail.org.; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA., Bledsoe JR; Department of Emergency Medicine, Intermountain Medical Center, Salt Lake City, UT, USA.; Department of Emergency Medicine, Stanford University, Stanford, CA, USA., Muhlestein JB; Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA.; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA., May HT; Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA., Peltan ID; Pulmonary and Critical Care, Intermountain Medical Center, Salt Lake City, Utah, USA.; Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, USA., Webb BJ; Division of Infectious Diseases and Clinical Epidemiology, Department of Medicine, Intermountain Medical Center, Salt Lake City, Utah, USA.; Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA, USA., Carlquist JF; Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA.; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA., Bennett ST; Intermountain Central Laboratory, Intermountain Medical Center, Salt Lake City, UT, USA.; Department of Pathology, University of Utah, Salt Lake City, UT, USA., Rea S; Care Transformation Information Systems, Intermountain Healthcare, Salt Lake City, UT, USA., Bair TL; Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA., Grissom CK; Pulmonary and Critical Care, Intermountain Medical Center, Salt Lake City, Utah, USA.; Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, USA., Knight S; Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA., Ronnow BS; Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA., Le VT; Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA., Stenehjem E; Division of Infectious Diseases and Clinical Epidemiology, Department of Medicine, Intermountain Medical Center, Salt Lake City, Utah, USA.; Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA, USA., Woller SC; Department of Medicine, Intermountain Medical Center, Salt Lake City, UT, USA.; Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA., Knowlton KU; Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA.; Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, USA., Anderson JL; Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA.; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2022 Mar 24; Vol. 12 (3), pp. e053864. Date of Electronic Publication: 2022 Mar 24.
DOI:	10.1136/bmjopen-2021-053864
Abstrakt:	Objectives: The Intermountain Risk Score (IMRS), composed using published sex-specific weightings of parameters in the complete blood count (CBC) and basic metabolic profile (BMP), is a validated predictor of mortality. We hypothesised that IMRS calculated from prepandemic CBC and BMP predicts COVID-19 outcomes and that IMRS using laboratory results tested at COVID-19 diagnosis is also predictive. Design: Prospective observational cohort study. Setting: Primary, secondary, urgent and emergent care, and drive-through testing locations across Utah and in sections of adjacent US states. Viral RNA testing for SARS-CoV-2 was conducted from 3 March to 2 November 2020. Participants: Patients aged ≥18 years were evaluated if they had CBC and BMP measured in 2019 and tested positive for COVID-19 in 2020. Primary and Secondary Outcome Measures: The primary outcome was a composite of hospitalisation or mortality, with secondary outcomes being hospitalisation and mortality separately. Results: Among 3883 patients, 8.2% were hospitalised and 1.6% died. Subjects with low, mild, moderate and high-risk IMRS had the composite endpoint in 3.5% (52/1502), 8.6% (108/1256), 15.5% (152/979) and 28.1% (41/146) of patients, respectively. Compared with low-risk, subjects in mild-risk, moderate-risk and high-risk groups had HR=2.33 (95% CI 1.67 to 3.24), HR=4.01 (95% CI 2.93 to 5.50) and HR=8.34 (95% CI 5.54 to 12.57), respectively. Subjects aged <60 years had HR=3.06 (95% CI 2.01 to 4.65) and HR=7.38 (95% CI 3.14 to 17.34) for moderate and high risks versus low risk, respectively; those ≥60 years had HR=1.95 (95% CI 0.99 to 3.86) and HR=3.40 (95% CI 1.63 to 7.07). In multivariable analyses, IMRS was independently predictive and was shown to capture substantial risk variation of comorbidities. Conclusions: IMRS, a simple risk score using very basic laboratory results, predicted COVID-19 hospitalisation and mortality. This included important abilities to identify risk in younger adults with few diagnosed comorbidities and to predict risk prior to SARS-CoV-2 infection. Competing Interests: Competing interests: BDH, HTM, BSR and JLA are inventors of clinical decision tools that are licensed to CareCentra and Alluceo. BDH is the principal investigator (PI) of grants related to clinical decision tools that were funded by Intermountain Healthcare’s Foundry innovation programme, the Intermountain Research and Medical Foundation, CareCentra, GlaxoSmithKline and AstraZeneca. BDH is a member of the scientific advisory board of Labme.ai. KUK is PI and BDH is a coinvestigator of a grant funded by the Patient-Centered Outcomes Research Institute. IDP was supported by a grant from the National Institute of General Medical Sciences (K23GM129661). Outside the current work, IDP has received grant support from the National Institutes of Health, Centers for Disease Control and Prevention, Janssen Pharmaceuticals and Immunexpress Inc, and funding to his institution from Regeneron Pharmaceuticals. The authors have no other potential conflicts of interest to report. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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