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ACP Risk Grade: A Simple Mortality Index for Patients with Confirmed or Suspected Severe Acute Respiratory Syndrome Coronavirus 2 Disease (COVID-19) During the Early Stage of Outbreak in Wuhan, China

36 Pages Posted: 28 Feb 2020

See all articles by Jiatao Lu

Jiatao Lu

Wuhan Hankou Hospital

Shufang Hu

Wuhan Hankou Hospital - Department of Endocrinology

Rong Fan

Southern Medical University - Department of Infectious Diseases

Zhihong Liu

Southern Medical University - Department of Infectious Diseases; Chinese Academy of Sciences (CAS) - State Key Laboratory of Applied Microbiology in Southern China

Xueru Yin

Southern Medical University - Department of Infectious Diseases

Qiongya Wang

Wuhan Hankou Hospital

Qingquan Lv

Wuhan Hankou Hospital - Department of Medical Affairs

Zhifang Cai

Wuhan Hankou Hospital - Department of Respiratory Diseases

Haijun Li

Wuhan Hankou Hospital - Department of Radiology

Yuhai Hu

Wuhan Hankou Hospital - Department of Laboratory Medicine

Ying Han

Wuhan Hankou Hospital - Department of Nursing

Hongping Hu

Wuhan Hankou Hospital - Department of Emergency

Wenyong Gao

Wuhan Hankou Hospital - Department of Neurology

Shibo Feng

Wuhan Hankou Hospital - Department of Orthopaedics

Qiongfang Liu

Wuhan Hankou Hospital - Department of Nosocomial Infection Administration

Hui Li

Southern Medical University - Department of Infectious Diseases

Jian Sun

Southern Medical University - Department of Infectious Diseases

Jie Peng

Southern Medical University - Nanfang Hospital

Xuefeng Yi

Health Commission of Guangdong Province

Zixiao Zhou

Health Commission of Guangdong Province

Yabing Guo

Wuhan Hankou Hospital

Jinlin Hou

Southern Medical University - Department of Infectious Diseases

More...

Abstract

Background: Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) outbreaks in Wuhan, China, healthcare systems capacities in highly endemic areas have been overwhelmed. Approaches to efficient management are urgently needed and key to a quicker control of the outbreaks and casualties. We aimed to characterize the clinical features of hospitalized patients with confirmed or suspected COVID-19, and develop a mortality risk index for COVID-19 patients.

Methods: In this retrospective one-centre cohort study, we included all the confirmed or suspected COVID-19 patients hospitalized in a COVID-19-designated hospital from January 21 to February 5, 2020. Demographic, clinical, laboratory, radiological and clinical outcome data were collected from the hospital information system, nursing records and laboratory reports.

Findings: Of 577 patients with at least one post-admission evaluation, the median age was 55 years (interquartile range [IQR], 39 - 66); 254 (44·0%) were men; 22·8% (100/438) were severe pneumonia on admission, and 37·7% (75/199) patients were SARS-CoV-2 positive. The clinical, laboratory and radiological data were comparable between positive and negative SARS-CoV-2 patients. During a median follow-up of 8·4 days (IQR, 5·8 - 12·0), 39 patients died with a 12-day cumulative mortality of 8·7% (95% CI, 5·9% to 11·5%). A simple mortality risk index (called ACP index), composed of Age and C-reactive Protein, was developed. By applying the ACP index, patients were categorized into three grades. The 12-day cumulative mortality in grade three (age ≥ 60 years and CRP ≥ 34 mg/L) was 33·2% (95% CI, 19·8% to 44·3%), which was significantly higher than those of grade two (age ≥ 60 years and CRP < 34 mg/L; age < 60 years and CRP ≥ 34 mg/L; 5·6% [95% CI, 0 to 11·3%]) and grade one (age < 60 years and CRP < 34 mg/L, 0%) (P <0·001), respectively.

Interpretation: The ACP index can predict COVID-19 related short-term mortality, which may be a useful and convenient tool for quickly establishing a COVID-19 hierarchical management system that can greatly reduce the medical burden and therefore mortality in highly endemic areas.

Funding Statement: Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program.

Declaration of Interests: The authors stated: "None reported."

Ethics Approval Statement: The study was conducted in accordance with the guidelines of the Declaration of Helsinki and the principles of good clinical practice, and was approved by the Nanfang Hospital Ethics Committee (NFEC-2020-026).

Keywords: severe acute respiratory syndrome coronavirus 2; coronavirus disease 2019; confirmed; suspected; mortality; risk index

Suggested Citation

Lu, Jiatao and Hu, Shufang and Fan, Rong and Liu, Zhihong and Yin, Xueru and Wang, Qiongya and Lv, Qingquan and Cai, Zhifang and Li, Haijun and Hu, Yuhai and Han, Ying and Hu, Hongping and Gao, Wenyong and Feng, Shibo and Liu, Qiongfang and Li, Hui and Sun, Jian and Peng, Jie and Yi, Xuefeng and Zhou, Zixiao and Guo, Yabing and Hou, Jinlin, ACP Risk Grade: A Simple Mortality Index for Patients with Confirmed or Suspected Severe Acute Respiratory Syndrome Coronavirus 2 Disease (COVID-19) During the Early Stage of Outbreak in Wuhan, China (February 20, 2020). Available at SSRN: https://ssrn.com/abstract=3543603 or http://dx.doi.org/10.2139/ssrn.3543603

Jiatao Lu

Wuhan Hankou Hospital

China

Shufang Hu

Wuhan Hankou Hospital - Department of Endocrinology

China

Rong Fan

Southern Medical University - Department of Infectious Diseases

Guangdong
China

Zhihong Liu

Southern Medical University - Department of Infectious Diseases

Guangdong
China

Chinese Academy of Sciences (CAS) - State Key Laboratory of Applied Microbiology in Southern China

Guangzhou, 510070
China

Xueru Yin

Southern Medical University - Department of Infectious Diseases

Guangdong
China

Qiongya Wang

Wuhan Hankou Hospital

China

Qingquan Lv

Wuhan Hankou Hospital - Department of Medical Affairs

China

Zhifang Cai

Wuhan Hankou Hospital - Department of Respiratory Diseases

China

Haijun Li

Wuhan Hankou Hospital - Department of Radiology

China

Yuhai Hu

Wuhan Hankou Hospital - Department of Laboratory Medicine

China

Ying Han

Wuhan Hankou Hospital - Department of Nursing

China

Hongping Hu

Wuhan Hankou Hospital - Department of Emergency

China

Wenyong Gao

Wuhan Hankou Hospital - Department of Neurology

China

Shibo Feng

Wuhan Hankou Hospital - Department of Orthopaedics

China

Qiongfang Liu

Wuhan Hankou Hospital - Department of Nosocomial Infection Administration

China

Hui Li

Southern Medical University - Department of Infectious Diseases

Guangdong
China

Jian Sun

Southern Medical University - Department of Infectious Diseases

Guangdong
China

Jie Peng

Southern Medical University - Nanfang Hospital ( email )

Guangzhou, Guangdong Province
China

Xuefeng Yi

Health Commission of Guangdong Province

China

Zixiao Zhou

Health Commission of Guangdong Province

China

Yabing Guo

Wuhan Hankou Hospital ( email )

China

Jinlin Hou (Contact Author)

Southern Medical University - Department of Infectious Diseases ( email )

Guangdong
China

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