Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Sci Rep. 2021 Nov 9;11(1):21923. doi: 10.1038/s41598-021-01452-7.
We developed a tool to guide decision-making for early triage of COVID-19 patients based on a predicted prognosis, using a Korean national cohort of 5,596 patients, and validated the developed tool with an external cohort of 445 patients treated in a single institution. Predictors chosen for our model were older age, male sex, subjective fever, dyspnea, altered consciousness, temperature ≥ 37.5 °C, heart rate ≥ 100 bpm, systolic blood pressure ≥ 160 mmHg, diabetes mellitus, heart disease, chronic kidney disease, cancer, dementia, anemia, leukocytosis, lymphocytopenia, and thrombocytopenia. In the external validation, when age, sex, symptoms, and underlying disease were used as predictors, the AUC used as an evaluation metric for our model's performance was 0.850 in predicting whether a patient will require at least oxygen therapy and 0.833 in predicting whether a patient will need critical care or die from COVID-19. The AUCs improved to 0.871 and 0.864, respectively, when additional information on vital signs and blood test results were also used. In contrast, the protocols currently recommended in Korea showed AUCs less than 0.75. An application for calculating the prognostic score in COVID-19 patients based on the results of this study is presented on our website ( https://nhimc.shinyapps.io/ih-psc/ ), where the results of the validation ongoing in our institution are periodically updated.
我们开发了一种工具，通过对 5596 名韩国患者的全国队列进行预测预后，来指导 COVID-19 患者的早期分诊决策，并使用单机构治疗的 445 名患者的外部队列对开发的工具进行验证。我们的模型选择的预测因素为年龄较大、男性、主观发热、呼吸困难、意识改变、体温≥37.5°C、心率≥100 bpm、收缩压≥160mmHg、糖尿病、心脏病、慢性肾脏病、癌症、痴呆、贫血、白细胞增多、淋巴细胞减少和血小板减少。在外部验证中，当使用年龄、性别、症状和基础疾病作为预测因素时，我们模型性能的评估指标 AUC 用于预测患者是否需要至少吸氧的 AUC 为 0.850，用于预测患者是否需要重症监护或死于 COVID-19 的 AUC 为 0.833。当还使用生命体征和血液检查结果的其他信息时，AUC 分别提高到 0.871 和 0.864。相比之下，目前在韩国推荐的方案显示 AUC 小于 0.75。本研究结果的 COVID-19 患者预后评分计算器应用程序已在我们的网站（https://nhimc.shinyapps.io/ih-psc/）上发布，我们机构正在进行的验证结果将定期更新。
