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An Algorithm for Classifying Patients Most Likely to Develop Severe Coronavirus Disease 2019 Illness

Michael W Kattan1, Xinge Ji1, Alex Milinovich1

  • 1Quantitative Health Science Department, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.

Critical Care Explorations
|December 23, 2020
PubMed

Insights

Researchers developed a COVID-19 risk algorithm to predict severe illness (ICU admission or death) upon testing positive. This tool helps identify high-risk individuals for targeted interventions and resource allocation.

Area of Science:

  • Infectious Diseases
  • Medical Informatics
  • Public Health

Background:

  • Coronavirus disease 2019 (COVID-19) poses a significant public health threat, with varying severity among infected individuals.
  • Predicting severe outcomes is crucial for effective patient management and resource allocation.

Purpose of the Study:

  • To develop and validate an algorithm for predicting individualized risk of severe COVID-19 (ICU admission or death) following a positive test.
  • To aid in clinical decision-making and public health strategies.

Main Methods:

  • Retrospective cohort study utilizing data from the Cleveland Clinic Health System.
  • Development and validation cohorts were established using a temporal split of COVID-19 positive cases (March-July 2020).
  • Fine and Gray competing risk regression modeling was employed to identify risk factors.

Main Results:

  • The study included 4,520 patients in the development set and 3,150 in the validation set.
  • Approximately 9% of patients experienced severe outcomes (ICU admission or death) within two weeks of a positive COVID-19 test.
  • A proposed 15% risk cut-point effectively stratified patients, identifying those with a 21% risk of severe disease versus a 96% chance of avoiding severe outcomes.

Conclusions:

  • An internally validated algorithm can accurately assess the risk of severe COVID-19 outcomes upon diagnosis.
  • The algorithm can inform critical decisions regarding resource allocation, workplace safety, and vaccination prioritization.
  • Individualized risk assessment is vital for managing the impact of COVID-19.
Abstract

Keywords:
coronavirus disease 2019hospitalizationintensive careoutcome predictionpandemicsevere acute respiratory syndrome coronavirus 2

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