The mNCP-SPI Score Predicting Risk of Severe COVID-19 among Mild-Pneumonia Patients on Admission

Abstract

Lingxi Guo,1,2,* Weining Xiong,3,* Dong Liu,1,2,* Yun Feng,1,2,* Peng Wang,4,* Xuan Dong,5,* Rong Chen,1,2,* Yi Wang,6 Lei Zhang,6 Jingwen Huang,1,2 Hanssa Dwarka Summah,7 Fangying Lu,1,2 Yusang Xie,1,2 Huihuang Lin,1,2 Jiayang Yan,1,2 Hongzhou Lu,8 Min Zhou,1,2 Jieming Qu1,2 1Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 4Departement of Respiratory and Critical Care Medicine, Baoshan Branch of Shanghai First People’s Hospital, Shanghai, People’s Republic of China; 5Tuberculosis and Respiratory Department, Wuhan Jinyintan Hospital, Wuhan, People’s Republic of China; 6Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Cite of National Clinical Research Center for Respiratory Disease, Wuhan Clinical Medical Research Center for Chronic Airway Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, People’s Republic of China; 7Chest Department, Poudre D’Or Chest Hospital, Riviere du Rempart, Mauritius; 8Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jieming QuDepartment of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People’s Republic of ChinaEmail [email protected] ZhouDepartment of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People’s Republic of ChinaEmail [email protected]: To predict the risk of developing severe pneumonia among mild novel coronavirus pneumonia (mNCP) patients on admission.Methods: A retrospective cohort study was conducted at three hospitals in Shanghai and Wuhan from January 2020 to February 2020. Real-time polymerasechain–reaction assays were used to detect COVID-19. A total of 529 patients diagnosed with NCP were recruited from three hospitals and classified by four severity types during hospitalization following the standards of the Chinese Diagnosis and Treatment of Pneumonia Caused by New Coronavirus Infection (eighth version). Patients were excluded if admitted by ICU on admission (n=92, on a general ward while meeting the condition of severe or critical type on admission (n=25), or there was insufficient clinical information (n=64). In sum, 348 patients with mNCP were finally included, and 68 developed severe pneumonia.Results: mNCP severity prognostic index values were calculated based on multivariate logistic regression: history of diabetes (OR 2.064, 95% CI 1.010– 4.683; p=0.043), time from symptom onset to admission ≥ 7 days (OR 1.945, 95% CI 1.054– 3.587; p=0.033), lymphocyte count ≤ 0.8 (OR 1.816, 95% CI 1.008– 3.274; p=0.047), myoglobin ≥ 90 mg/L (OR 2.496, 95% CI 1.235– 5.047; p=0.011), and D-dimer ≥ 0.5 mg/L (OR 2.740, 95% CI 1.395– 5.380; p=0.003). This model showed a c-statistics of 0.747, with sensitivity and specificity 0.764 and 0.644, respectively, under cutoff of 165.Conclusion: We designed a clinical predictive tool for risk of severe pneumonia among mNCP patients to provided guidance for medicines. Further studies are required for external validation.Keywords: novel coronavirus pneumonia, predicting score, severe pneumonia

Keywords

• novel coronavirus pneumonia
• predicting score
• severe pneumonia