%0 Journal Article
%T Development and Validation of a Two-Step Predictive Risk Stratification Model for Coronavirus Disease 2019 In-hospital Mortality: A Multicenter Retrospective Cohort Study.
%A Li Y
%A Kong Y
%A Ebell MH
%A Martinez L
%A Cai X
%A Lennon RP
%A Tarn DM
%A Mainous AG
%A Zgierska AE
%A Barrett B
%A Tuan WJ
%A Maloy K
%A Goyal M
%A Krist AH
%A Gal TS
%A Sung MH
%A Li C
%A Jin Y
%A Shen Y
%J Front Med (Lausanne)
%V 9
%N 0
%D 2022
%M 35463024
%F 5.058
%R 10.3389/fmed.2022.827261
%X <B>UNASSIGNED: </B>An accurate prognostic score to predict mortality for adults with COVID-19 infection is needed to understand who would benefit most from hospitalizations and more intensive support and care. We aimed to develop and validate a two-step score system for patient triage, and to identify patients at a relatively low level of mortality risk using easy-to-collect individual information.<BR><B>UNASSIGNED: </B>Multicenter retrospective observational cohort study.<BR><B>UNASSIGNED: </B>Four health centers from Virginia Commonwealth University, Georgetown University, the University of Florida, and the University of California, Los Angeles.<BR><B>UNASSIGNED: </B>Coronavirus Disease 2019-confirmed and hospitalized adult patients.<BR><B>UNASSIGNED: </B>We included 1,673 participants from Virginia Commonwealth University (VCU) as the derivation cohort. Risk factors for in-hospital death were identified using a multivariable logistic model with variable selection procedures after repeated missing data imputation. A two-step risk score was developed to identify patients at lower, moderate, and higher mortality risk. The first step selected increasing age, more than one pre-existing comorbidities, heart rate >100 beats/min, respiratory rate ≥30 breaths/min, and SpO2 <93% into the predictive model. Besides age and SpO2, the second step used blood urea nitrogen, absolute neutrophil count, C-reactive protein, platelet count, and neutrophil-to-lymphocyte ratio as predictors. C-statistics reflected very good discrimination with internal validation at VCU (0.83, 95% CI 0.79-0.88) and external validation at the other three health systems (range, 0.79-0.85). A one-step model was also derived for comparison. Overall, the two-step risk score had better performance than the one-step score.<BR><B>UNASSIGNED: </B>The two-step scoring system used widely available, point-of-care data for triage of COVID-19 patients and is a potentially time- and cost-saving tool in practice.