Novel Calculators Identify Hospitalized COVID-19 Patients at Greatest Risk of Requiring Mechanical Ventilation or of In-Hospital Death

Two novel calculators for predicting which patients admitted to the hospital with COVID-19 are at greatest risk of requiring mechanical ventilation or of in-hospital death have been developed and validated by researchers.

In a new study, researchers at the Massachusetts General Hospital (MGH; Boston, MA, USA) have described how these models could enable clinicians to better stratify risk in COVID-infected patients to optimize care and resource utilization in hospitals faced with ICU capacity constraints. The research team compiled clinical information from 1,042 patients confirmed with COVID-19 who were admitted to five hospitals in the Mass General Brigham health care system during the first three months of the pandemic. Significant associations between clinical, hemodynamic, and laboratory data and the endpoints of in-hospital mortality and mechanical ventilation provided the building blocks for two separate risk stratification models known as the VICE (Ventilation in COVID Estimate) and DICE (Death in COVID Estimate) scores.

Predictive VICE factors uncovered by researchers were diabetes mellitus, oxygen saturation of the blood, and two inflammatory markers: C-reactive protein and lactate dehydrogenase. DICE factors predictive of mortality were age, male sex, coronary artery disease, diabetes mellitus, body mass index, platelet count, and a variety of inflammatory and infectious markers. Researchers were surprised to learn that age was not a significant predictor of whether a patient would require mechanical ventilation. Indeed, other than the youngest patients, the percentage of hospitalized COVID-19 patients requiring mechanical ventilation was similar in each decade of life, though there was a clear correlation between age and risk of in-hospital death, with only 15% survival in patients over 84 requiring mechanical ventilation. Nor was age a predictor of how long a patient would need ventilation. The study found that 59% of patients in the 25-to-34 age group required more than 14 days of ventilation, similar to older age groups.

Another significant finding from the study was that regular use of statins was associated with reduced in-hospital mortality, underscoring the strong links among COVID-19, cardiovascular disease, and inflammation. In another encouraging finding, researchers did not observe any relationship between minority ethnic background of COVID-19 patients and worse clinical outcomes after adjusting for clinical risk.

"By inputting clinical values into these online calculators, physicians can risk-stratify COVID-19 patients upon admission and determine which ones may need the most intensive care and management," says lead author Christopher Nicholson, PhD, a senior research fellow with the MGH Cardiovascular Research Center. "These risk scores allow them to predict with greater than 80% accuracy - higher than established models - patient outcomes, as well as demand for mechanical ventilators and ICU beds, which could impact end-of-life decisions involving COVID-19 patients."

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