PLoS ONE (Jan 2022)

Predictors of mortality among hospitalized COVID-19 patients and risk score formulation for prioritizing tertiary care-An experience from South India.

  • Narendran Gopalan,
  • Sumathi Senthil,
  • Narmadha Lakshmi Prabakar,
  • Thirumaran Senguttuvan,
  • Adhin Bhaskar,
  • Muthukumaran Jagannathan,
  • Ravi Sivaraman,
  • Jayalakshmi Ramasamy,
  • Ponnuraja Chinnaiyan,
  • Vijayalakshmi Arumugam,
  • Banumathy Getrude,
  • Gautham Sakthivel,
  • Vignes Anand Srinivasalu,
  • Dhanalakshmi Rajendran,
  • Arunjith Nadukkandiyil,
  • Vaishnavi Ravi,
  • Sadiqa Nasreen Hifzour Rahamane,
  • Nirmal Athur Paramasivam,
  • Tamizhselvan Manoharan,
  • Maheshwari Theyagarajan,
  • Vineet Kumar Chadha,
  • Mohan Natrajan,
  • Baskaran Dhanaraj,
  • Manoj Vasant Murhekar,
  • Shanthi Malar Ramalingam,
  • Padmapriyadarsini Chandrasekaran

DOI
https://doi.org/10.1371/journal.pone.0263471
Journal volume & issue
Vol. 17, no. 2
p. e0263471

Abstract

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BackgroundWe retrospectively data-mined the case records of Reverse Transcription Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients hospitalized to a tertiary care centre to derive mortality predictors and formulate a risk score, for prioritizing admission.Methods and findingsData on clinical manifestations, comorbidities, vital signs, and basic lab investigations collected as part of routine medical management at admission to a COVID-19 tertiary care centre in Chengalpattu, South India between May and November 2020 were retrospectively analysed to ascertain predictors of mortality in the univariate analysis using their relative difference in distribution among 'survivors' and 'non-survivors'. The regression coefficients of those factors remaining significant in the multivariable logistic regression were utilised for risk score formulation and validated in 1000 bootstrap datasets. Among 746 COVID-19 patients hospitalised [487 "survivors" and 259 "non-survivors" (deaths)], there was a slight male predilection [62.5%, (466/746)], with a higher mortality rate observed among 40-70 years age group [59.1%, (441/746)] and highest among diabetic patients with elevated urea levels [65.4% (68/104)]. The adjusted odds ratios of factors [OR (95% CI)] significant in the multivariable logistic regression were SaO23; 3.01 (1.61-5.83), Age ≥50 years;2.52 (1.45-4.43), Pulse Rate ≥100/min: 2.02 (1.19-3.47) and coexisting Diabetes Mellitus; 1.73 (1.02-2.95) with hypertension and gender not retaining their significance. The individual risk scores for SaO23-11, Age ≥50 years-9, Pulse Rate ≥100/min-7 and coexisting diabetes mellitus-6, acronymed collectively as 'OUR-ARDs score' showed that the sum of scores ≥ 25 predicted mortality with a sensitivity-90%, specificity-64% and AUC of 0.85.ConclusionsThe 'OUR ARDs' risk score, derived from easily assessable factors predicting mortality, offered a tangible solution for prioritizing admission to COVID-19 tertiary care centre, that enhanced patient care but without unduly straining the health system.