Development and validation of a dynamic 48-hour in-hospital mortality risk stratification for COVID-19 in a UK teaching hospital: a retrospective cohort study
| Autor: | David Halsall, Claire S. Waddington, Tom Bdm, Effrossyni Gkrania-Klotsas, Goudie Rjb, Taylor, Victoria L. Keevil, Martin Wiegand, Jacobus Preller, Sarah L. Cowan |
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| Přispěvatelé: | Wiegand, Martin [0000-0003-0276-658X], Cowan, Sarah L [0000-0001-9149-3530], Waddington, Claire S [0000-0002-4120-6027], Keevil, Victoria L [0000-0001-6148-0640], Tom, Brian DM [0000-0002-3335-9322], Gkrania-Klotsas, Effrossyni [0000-0002-0930-8330], Preller, Jacobus [0000-0001-5706-816X], Goudie, Robert JB [0000-0001-9554-1499], Apollo - University of Cambridge Repository, Tom, Brian [0000-0002-3335-9322], Goudie, Robert [0000-0001-9554-1499], Wiegand, M [0000-0003-0276-658X], Cowan, SL [0000-0001-9149-3530], Waddington, CS [0000-0002-4120-6027], Keevil, VL [0000-0001-6148-0640], Tom, BDM [0000-0002-3335-9322], Gkrania-Klotsas, E [0000-0002-0930-8330], Preller, J [0000-0001-5706-816X], Goudie, RJB [0000-0001-9554-1499] |
| Rok vydání: | 2023 |
| Předmět: |
medicine.medical_specialty
Coronavirus disease 2019 (COVID-19) statistics & research methods risk management Risk Assessment Teaching hospital Heart rate medicine Humans In patient Hospital Mortality Internal validation Hospitals Teaching Retrospective Studies business.industry COVID-19 Retrospective cohort study General Medicine United Kingdom Test score Emergency medicine Risk stratification epidemiology business |
| Zdroj: | BMJ open, 12(9):e060026 |
| DOI: | 10.17863/cam.94264 |
| Popis: | OBJECTIVES: To develop a disease stratification model for COVID-19 that updates according to changes in a patient's condition while in hospital to facilitate patient management and resource allocation. DESIGN: In this retrospective cohort study, we adopted a landmarking approach to dynamic prediction of all-cause in-hospital mortality over the next 48 hours. We accounted for informative predictor missingness and selected predictors using penalised regression. SETTING: All data used in this study were obtained from a single UK teaching hospital. PARTICIPANTS: We developed the model using 473 consecutive patients with COVID-19 presenting to a UK hospital between 1 March 2020 and 12 September 2020; and temporally validated using data on 1119 patients presenting between 13 September 2020 and 17 March 2021. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome is all-cause in-hospital mortality within 48 hours of the prediction time. We accounted for the competing risks of discharge from hospital alive and transfer to a tertiary intensive care unit for extracorporeal membrane oxygenation. RESULTS: Our final model includes age, Clinical Frailty Scale score, heart rate, respiratory rate, oxygen saturation/fractional inspired oxygen ratio, white cell count, presence of acidosis (pH Martin Wiegand was funded by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014). Victoria L. Keevil was funded by the MRC/NIHR Clinical Academic Research Partnership Grant (CARP) [grant code MR/T023902/1]. Vince Taylor was funded by the Cancer Research UK Cambridge Centre. Effrossyni Gkrania-Klotsas was supported by the NIHR Clinical Research Network (CRN) Greenshoots Award. Brian D. M. Tom and Robert J. B. Goudie were funded by the UKRI Medical Research Council (MRC) [programme code MC_UU_00002/2] and supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014). |
| Databáze: | OpenAIRE |
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