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A Predictive Score at Admission for Respiratory Failure Among Hospitalized Patients with Confirmed 2019 Coronavirus Disease: A Simple Tool for a Complex Problem

46 Pages Posted: 15 Jul 2020

See all articles by Antonio Lalueza

Antonio Lalueza

University Hospital 12 de Octubre - Department of Internal Medicine

Jaime Lora-Tamayo

Instituto de Investigación Sanitaria Hospital "12 de Octubre" - Research Insitute i+12

Guillermo Maestro-de la Calle

Department of Internal Medicine, University Hospital 12 de Octubre

María Dolores Folgueira

Instituto de Investigación Sanitaria Hospital "12 de Octubre" - Department of Microbiology

Estíbaliz Arrieta

Department of Internal Medicine, University Hospital 12 de Octubre

Borja de Miguel-Campo

Department of Internal Medicine, University Hospital 12 de Octubre

Raquel Díaz-Simón

Department of Internal Medicine, University Hospital 12 de Octubre

David Lora

Research Institute of Hospital 12 de Octubre (imas+12)

Cristina de la Calle

Department of Internal Medicine, University Hospital 12 de Octubre

Mikel Mancheño-Losa

Department of Internal Medicine, University Hospital 12 de Octubre

Álvaro Marchán-López

Department of Internal Medicine, University Hospital 12 de Octubre

Ana García-Reyne

Department of Internal Medicine, University Hospital 12 de Octubre

Mario Fernández-Ruiz

Instituto de Investigación Sanitaria Hospital "12 de Octubre" - Unit of Infectious Diseases

Javier Sayas-Catalán

Research Institute of Hospital 12 de Octubre (imas+12)

Antonio Serrano

Research Institute of Hospital 12 de Octubre (imas+12)

Cecilia Cueto-Felgueroso

Department of Biochemistry, University Hospital 12 de Octubre

Rafael San Juan

Department of Medicine, School of Medicine, Complutense University

Rocío García-García

Department of Respiratory Medicine,University Hospital 12 de Octubre

Mercedes Catalán

Department of Intensive Care Medicine, University Hospital 12 de Octubre

José María Aguado

Instituto de Investigación Sanitaria Hospital "12 de Octubre" - Unit of Infectious Diseases

Carlos Lumbreras

Instituto de Investigación Sanitaria Hospital "12 de Octubre" - Department of Internal Medicine

COVID+12 Group

Independent

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Abstract

Background: Coronavirus Disease 2019 (COVID-19) pandemic has implacably stricken on the wellness of many countries and their health-care systems. The aim of the present study is analyze the clinical characteristics of the initial wave of patients with COVID-19 attended in our center, and to identify the key variables predicting the development of respiratory failure.

Methods: We retrospectively recruited all hospitalized adult patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rRT-PCR assay performed on respiratory samples from March 2nd to 18th, 2020. Patients were followed up to May 1st, 2020 or death. Respiratory failure was defined as a PaO2/FiO2 ratio ≤200 mm Hg or the need for mechanical ventilation (either non-invasive positive pressure ventilation or invasive mechanical ventilation).

Findings: We included 521 patients of whom 416 (81%) had abnormal Chest X-ray on admission. Median age was 64·6 ± 18·2 years, with 317 patients (60.8%) over 60 years. One hundred eighty-one (34·7%) developed respiratory failure after a median time from onset of symptoms of 9 days (IQR: 6-11) and the in-hospital mortality was 23·8% (124/521). The modelling process concluded into a logistic regression multivariable analysis and a predictive score at admission. Age, peripheral pulse oximetry, lymphocyte count, lactate dehydrogenase and C-reactive protein were the selected variables. The model has a good discriminative capacity with an area under the ROC curve of 0·85 (0·82-0·88).

Interpretation:  The application of a simple and reliable score at admission seems to be a useful tool to predict respiratory failure in hospitalized COVID-19 patients.

Funding: This study was supported by the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (COVID-19 research call COV20/00181) — co‐ financed by the European Development Regional Fund “A way to achieve Europe”. Mikel Mancheño-Losa was supported by a Research Contract “Río Hortega” from the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (CM19/00226). Mario Fernández-Ruiz holds a research contract “Miguel Servet” from the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (CP 18/00073).

Declaration of Interests: The authors declared they do not have anything to disclose regarding conflict of interest with respect to this manuscript.

Ethics Approval Statement: The protocol was approved by the Hospital 12 de Octubre Clinical Research Ethics Committee (reference 20/117) and granted a waiver of informed consent due to its retrospective observational design.

Keywords: respiratory failure; SARS-CoV2; COVID-19; score; outcome

Suggested Citation

Lalueza, Antonio and Lora-Tamayo, Jaime and Maestro-de la Calle, Guillermo and Folgueira, María Dolores and Arrieta, Estíbaliz and de Miguel-Campo, Borja and Díaz-Simón, Raquel and Lora, David and de la Calle, Cristina and Mancheño-Losa, Mikel and Marchán-López, Álvaro and García-Reyne, Ana and Fernández-Ruiz, Mario and Sayas-Catalán, Javier and Serrano, Antonio and Cueto-Felgueroso, Cecilia and San Juan, Rafael and García-García, Rocío and Catalán, Mercedes and María Aguado, José and Lumbreras, Carlos and Group, COVID+12, A Predictive Score at Admission for Respiratory Failure Among Hospitalized Patients with Confirmed 2019 Coronavirus Disease: A Simple Tool for a Complex Problem (5/31/2020). Available at SSRN: https://ssrn.com/abstract=3618216 or http://dx.doi.org/10.2139/ssrn.3618216

Antonio Lalueza (Contact Author)

University Hospital 12 de Octubre - Department of Internal Medicine ( email )

Madrid
Spain

Jaime Lora-Tamayo

Instituto de Investigación Sanitaria Hospital "12 de Octubre" - Research Insitute i+12

Av. Cordoba, s/n
Madrid, 28041
Spain

Guillermo Maestro-de la Calle

Department of Internal Medicine, University Hospital 12 de Octubre

María Dolores Folgueira

Instituto de Investigación Sanitaria Hospital "12 de Octubre" - Department of Microbiology

Madrid
Spain

Estíbaliz Arrieta

Department of Internal Medicine, University Hospital 12 de Octubre

Borja De Miguel-Campo

Department of Internal Medicine, University Hospital 12 de Octubre

Raquel Díaz-Simón

Department of Internal Medicine, University Hospital 12 de Octubre

David Lora

Research Institute of Hospital 12 de Octubre (imas+12)

Cristina De la Calle

Department of Internal Medicine, University Hospital 12 de Octubre

Mikel Mancheño-Losa

Department of Internal Medicine, University Hospital 12 de Octubre

Álvaro Marchán-López

Department of Internal Medicine, University Hospital 12 de Octubre

Ana García-Reyne

Department of Internal Medicine, University Hospital 12 de Octubre

Mario Fernández-Ruiz

Instituto de Investigación Sanitaria Hospital "12 de Octubre" - Unit of Infectious Diseases

Madrid
Spain

Javier Sayas-Catalán

Research Institute of Hospital 12 de Octubre (imas+12)

Antonio Serrano

Research Institute of Hospital 12 de Octubre (imas+12)

Cecilia Cueto-Felgueroso

Department of Biochemistry, University Hospital 12 de Octubre

Rafael San Juan

Department of Medicine, School of Medicine, Complutense University

Rocío García-García

Department of Respiratory Medicine,University Hospital 12 de Octubre ( email )

Mercedes Catalán

Department of Intensive Care Medicine, University Hospital 12 de Octubre

José María Aguado

Instituto de Investigación Sanitaria Hospital "12 de Octubre" - Unit of Infectious Diseases

Madrid
Spain

Carlos Lumbreras

Instituto de Investigación Sanitaria Hospital "12 de Octubre" - Department of Internal Medicine

Madrid
Spain

COVID+12 Group

Independent

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