The prognostic value of estimated glomerular filtration rate on admission for death within 30 days among COVID-19 inpatients using fractional polynomial and spline smoothing.

Autor: Ayubi, Erfan, Alemi, Mohsen, Torkamanasadi, Fatemeh, Khosronezhad, Saman, Faghih Soleimani, Mobin, Khazaei, Salman
Zdroj: International Urology & Nephrology; Oct2023, Vol. 55 Issue 10, p2657-2666, 10p
Abstrakt: Background: The common regression models included estimated glomerular filtration rate (eGFR) in the continuous and categorical form for predicting the mortality in COVID-19 inpatients. However, the relationship may be non-linear, and categorizing implies a loss of information. This study aimed to assess the effect of eGFR on admission on death within 30 days among COVID-19 inpatients using flexible and smooth transformations of eGFR and compare the results against the common models. Methods: A retrospective study was conducted on hospitalized COVID-19 patients between April 2019 and July 2019 in Hamadan, Western Iran. The effect of eGFR on the death within 30 days was evaluated using different modeling: categorization, linear, unrestricted cubic spline (USC) with 4 knots, and fractional polynomial (FP). The results adjusted for older age and intensive care unit (ICU) admission. Discrimination power and model performance of the best-fitting model was evaluated using the area under the ROC (AUROC) and Brier score. Results: In total, 2945 patients (median age 61 years; interquartile range 48–73 years) were included, of whom the mortality rate was 9.23%. The relationship between the eGFR and death within 30 days is non-linear, so the degree-2 FP with powers (− 2, − 1) is the best-fitting model. Using the FP model, the risk increased exponentially in eGFR < 45 and then increased linearly and slowly. The AUROC of the FP model involving eGFR, older age, and ICU admission was 0.92 (95% CI 0.90–0.93) with a Brier score of 0.09. Conclusion: There is a non-linear and asymmetric relationship between eGFR and death within 30 days among COVID-19 inpatients. Kidney function can be measured in COCID-19 patients on admission to know better understanding about prognosis of the patients. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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