tetano
Editor, Senior Moderator
Chest. 2020 Apr 15. pii: S0012-3692(20)30710-8. doi: 10.1016/j.chest.2020.04.010. [Epub ahead of print]
Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China.
Chen R[SUP]1[/SUP], Liang W[SUP]1[/SUP], Jiang M[SUP]1[/SUP], Guan W[SUP]1[/SUP], Zhan C[SUP]1[/SUP], Wang T[SUP]1[/SUP], Tang C[SUP]1[/SUP], Sang L[SUP]1[/SUP], Liu J[SUP]1[/SUP], Ni Z[SUP]2[/SUP], Hu Y[SUP]3[/SUP], Liu L[SUP]4[/SUP], Shan H[SUP]5[/SUP], Lei C[SUP]6[/SUP], Peng Y[SUP]7[/SUP], Wei L[SUP]8[/SUP], Liu Y[SUP]9[/SUP], Hu Y[SUP]10[/SUP], Peng P[SUP]11[/SUP], Wang J[SUP]12[/SUP], Liu J[SUP]13[/SUP], Chen Z[SUP]14[/SUP], Li G[SUP]15[/SUP], Zheng Z[SUP]16[/SUP], Qiu S[SUP]17[/SUP], Luo J[SUP]18[/SUP], Ye C[SUP]19[/SUP], Zhu S[SUP]20[/SUP], Liu X[SUP]1[/SUP], Cheng L[SUP]1[/SUP], Ye F[SUP]1[/SUP], Zheng J[SUP]1[/SUP], Zhang N[SUP]1[/SUP], Li Y[SUP]1[/SUP], He J[SUP]1[/SUP], Li S[SUP]21[/SUP], Zhong N[SUP]22[/SUP]; Medical Treatment Expert Group for COVID-19.
Author information
Abstract
BACKGROUND:
The novel coronavirus disease 2019 (COVID-19) has become a global health emergency. Cumulative number of new confirmed case and death are still increasing out of China. However, the independent predicted factors associated with the fatal outcome remain uncertain.
METHODS:
A retrospective cohort of 1590 hospitalized subjects with COVID-19 throughout China was established. The prognostic effects of variables, including clinical features and laboratory findings, were analyzed using Kapla-Meier method and Cox proportional hazard model. A prognostic nomogram was formulated to predict the survival of patient with COVID-19.
RESULTS:
In this nationwide cohort, non-survivors showed higher incidence of elderly people, subjects with co-existing chronic illness, dyspnea and laboratory abnormalities on admission, compared with survivors. Multivariate Cox regression analysis showed that age≥75 (HR: 7.86, 95% CI: 2.44-25.35), age between 65-74 years (HR:3.43, 95%CI: 1.24-9.5), coronary heart disease (HR:4.28, 95%CI:1.14-16.13), cerebrovascular disease(HR:3.1, 95%CI:1.07-8.94), dyspnea (HR: 3.96, 95%CI:1.42-11), procalcitonin>0.5ng/ml(HR:8.72, 95%CI:3.42-22.28), aspartate aminotransferase>40U/liter (HR: 2.2, 95% CI: 1.1- 6.73) were independent risk factors associated with fatal outcome. A nomogram was established based on the results of multivariate analysis. The internal bootstrap resampling approach suggested the nomogram has sufficient discriminatory power with the C-index of 0.91 (95%CI 0.85-0.97). The calibration plots also demonstrated good consistence between the prediction and the observation.
CONCLUSIONS:
The proposed nomogram accurately predict clinical outcomes of patients with COVID-19 based on individual characteristics. Earlier identification, more intensive surveillance and appropriate therapy should be considered in patients with high risk.
Copyright ? 2020. Published by Elsevier Inc.
KEYWORDS:
COVID-19; fatal outcome; nomogram; risk factors
PMID:32304772DOI:10.1016/j.chest.2020.04.010
Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China.
Chen R[SUP]1[/SUP], Liang W[SUP]1[/SUP], Jiang M[SUP]1[/SUP], Guan W[SUP]1[/SUP], Zhan C[SUP]1[/SUP], Wang T[SUP]1[/SUP], Tang C[SUP]1[/SUP], Sang L[SUP]1[/SUP], Liu J[SUP]1[/SUP], Ni Z[SUP]2[/SUP], Hu Y[SUP]3[/SUP], Liu L[SUP]4[/SUP], Shan H[SUP]5[/SUP], Lei C[SUP]6[/SUP], Peng Y[SUP]7[/SUP], Wei L[SUP]8[/SUP], Liu Y[SUP]9[/SUP], Hu Y[SUP]10[/SUP], Peng P[SUP]11[/SUP], Wang J[SUP]12[/SUP], Liu J[SUP]13[/SUP], Chen Z[SUP]14[/SUP], Li G[SUP]15[/SUP], Zheng Z[SUP]16[/SUP], Qiu S[SUP]17[/SUP], Luo J[SUP]18[/SUP], Ye C[SUP]19[/SUP], Zhu S[SUP]20[/SUP], Liu X[SUP]1[/SUP], Cheng L[SUP]1[/SUP], Ye F[SUP]1[/SUP], Zheng J[SUP]1[/SUP], Zhang N[SUP]1[/SUP], Li Y[SUP]1[/SUP], He J[SUP]1[/SUP], Li S[SUP]21[/SUP], Zhong N[SUP]22[/SUP]; Medical Treatment Expert Group for COVID-19.
Author information
Abstract
BACKGROUND:
The novel coronavirus disease 2019 (COVID-19) has become a global health emergency. Cumulative number of new confirmed case and death are still increasing out of China. However, the independent predicted factors associated with the fatal outcome remain uncertain.
METHODS:
A retrospective cohort of 1590 hospitalized subjects with COVID-19 throughout China was established. The prognostic effects of variables, including clinical features and laboratory findings, were analyzed using Kapla-Meier method and Cox proportional hazard model. A prognostic nomogram was formulated to predict the survival of patient with COVID-19.
RESULTS:
In this nationwide cohort, non-survivors showed higher incidence of elderly people, subjects with co-existing chronic illness, dyspnea and laboratory abnormalities on admission, compared with survivors. Multivariate Cox regression analysis showed that age≥75 (HR: 7.86, 95% CI: 2.44-25.35), age between 65-74 years (HR:3.43, 95%CI: 1.24-9.5), coronary heart disease (HR:4.28, 95%CI:1.14-16.13), cerebrovascular disease(HR:3.1, 95%CI:1.07-8.94), dyspnea (HR: 3.96, 95%CI:1.42-11), procalcitonin>0.5ng/ml(HR:8.72, 95%CI:3.42-22.28), aspartate aminotransferase>40U/liter (HR: 2.2, 95% CI: 1.1- 6.73) were independent risk factors associated with fatal outcome. A nomogram was established based on the results of multivariate analysis. The internal bootstrap resampling approach suggested the nomogram has sufficient discriminatory power with the C-index of 0.91 (95%CI 0.85-0.97). The calibration plots also demonstrated good consistence between the prediction and the observation.
CONCLUSIONS:
The proposed nomogram accurately predict clinical outcomes of patients with COVID-19 based on individual characteristics. Earlier identification, more intensive surveillance and appropriate therapy should be considered in patients with high risk.
Copyright ? 2020. Published by Elsevier Inc.
KEYWORDS:
COVID-19; fatal outcome; nomogram; risk factors
PMID:32304772DOI:10.1016/j.chest.2020.04.010