New tools assess in-hospital death risk of Covid patients

The findings, published in the journal EClinicalMedicine, indicates that these models could enable clinicians to better stratify risk in Covid-infected patients to optimize care and resource utilization

New York: Researchers, including an Indian-origin, have developed two novel calculators for predicting which patients admitted to the hospital with Covid-19 are at greatest risk of requiring mechanical ventilation or in-hospital death.

The findings, published in the journal EClinicalMedicine, indicates that 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.

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“Using a combination of past medical history, vital signs, and laboratory results at the time of patient admission, we developed models that can differentiate between risk for mechanical ventilation and risk for in-hospital mortality,” said researcher Rajeev Malhotra from Massachusetts General Hospital (MGH).

“While other studies have focused on 30-day hospital outcomes, we followed all Covid-19 patients to the end of their hospital course since a significant number are hospitalized well beyond 30 days,” Malhotra added.

For the study, the team compiled this clinical information from 1,042 patients confirmed with Covid-19 who were admitted to five hospitals during the first three months of the pandemic.

“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,” said lead author Christopher Nicholson from the hospital.

“These risk scores allow them to predict with greater than 80 per cent 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,” Nicholson added.

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 per cent survival in patients over 84 requiring mechanical ventilation.

The study found that 59 per cent of patients in the 25-to-34 age group required more than 14 days of ventilation, similar to older age groups.