一个动态的预后模型,用于识别易受伤害的COVID-19患者,他们面临快速恶化的高风险
Priyanka Anand1, Elvira D'Andrea1, William Feldman1,2
1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Pharmacoepidemiology and drug safety
|August 13, 2024
概括
开发了一种新的预后模型,以预测疫苗可用后住院COVID-19患者的临床恶化. 这种更新的模型显示了令人满意的性能,改善了以前的版本,以获得更好的患者结果.
科学领域:
- 临床信息学 临床信息学
- 流行病学 流行病学
- 生物统计学 生物统计学
背景情况:
- 由于COVID-19的流行,需要开发预后模型来预测住院患者的临床恶化.
- 由于COVID-19疫苗的广泛可用性,以前的模型可能无法准确地反映患者的特征或疾病进展.
研究的目的:
- 验证以前发表的预后模型,用于预测住院COVID-19患者的临床恶化.
- 更新现有模型,使用疫苗后时代的数据来提高其预测性能.
主要方法:
- 利用实验室确认的COVID-19 (2020年3月至2021年11月) 成年患者的电子健康记录.
- 测试了现有模型的性能,并使用LASSO回归进行了更新,将数据分为开发 (70%) 和验证 (30%) 队列.
- 使用c-statistic和Brier分数评估模型性能.
主要成果:
- 原始模型在2020年11月以后的数据上显示了低于最佳的性能 (c-statistic=0.60).
- 更新后的模型结合了38个预测因素,包括18个不断变化的生物标志物,实现了性能改进 (c-statistic=0.77在开发中,0.73在验证中).
- 患者特征转移了疫苗接种后的可用性,在2021年6月之后观察到年轻患者和较少的并发病.
结论:
- 自疫苗可用以来,COVID-19住院病人的患者人口统计和临床特征发生了显著的变化.
- 成功开发了一种新的动态预后模型,在验证队列中表现出令人满意的预测性能.
- 这种更新的模型为预测当代COVID-19患者的疾病快速进展提供了更高的准确性.
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