COVID-19 'prediction model' uses data that can help determine if
patients' conditions are likely to worsen

Date:
September 23, 2020
Source:
Johns Hopkins Medicine
Summary:
Using a combination of demographic and clinical data gathered from
seven weeks of COVID-19 patient care early in the coronavirus
pandemic, researchers have published a 'prediction model' they
say can help other hospitals care for COVID-19 patients -- and
make important decisions about planning and resource allocations.



FULL STORY ========================================================================== Using a combination of demographic and clinical data gathered from seven
weeks of COVID-19 patient care early in the coronavirus pandemic, Johns
Hopkins researchers today published a "prediction model" they say can
help other hospitals care for COVID-19 patients -- and make important
decisions about planning and resource allocations.


========================================================================== Brian Garibaldi, M.D., associate professor of medicine at the Johns
Hopkins University School of Medicine, led a team that published in the
Annals of Internal Medicine the article that shares important lessons
learned in the care of COVID-19 patients between March 4 and April 24,
2020, at five Johns Hopkins hospitals in Maryland and Washington, D.C.

During those 52 days, The Johns Hopkins Hospital, Johns Hopkins Bayview
Medical Center, Howard County General Hospital, Suburban Hospital and
Sibley Memorial Hospital admitted a combined 827 people age 18 or older --
336 Black, 264 white, 135 Hispanic, 48 Asian, 2 Native American and 42 multiracial -- who tested positive for the coronavirus and had symptoms
of COVID-19.

From the data those patients generated, the researchers developed a
prediction model using a set of risk factors known to be associated
with COVID-19 to forecast how likely a patient's disease is to worsen
while being treated in a hospital and at what point in their care that
might happen. Among the risk factors researchers considered as part of
the model were a patient's age, body mass index (BMI), lung health and
chronic disease, as well as vital signs and the severity of a patient's COVID-19 symptoms at the time of admission.

The model, called the "COVID Inpatient Risk Calculator (CIRC)," is
available online (rsconnect.biostat.jhsph.edu/covid_predict/). Garibaldi
says the calculator is meant to help hospital physicians and other health
care providers assess the risk of a patient's condition worsening.

"This is some of what we've learned in the months since we started
seeing patients with COVID-19 at our hospitals," says Garibaldi. "As we continue to grapple with high numbers of COVID-19 infections across the
United States, it's important to share knowledge with our colleagues at
other hospitals." Among the highlights of the study was the rapidity
with which the disease can progress from mild or moderate to severe, particularly if a patient had all or some of the risk factors associated
with the disease. Forty-five of the patients in the study had severe
COVID-19 when they were admitted to the hospital. But 120 patients
developed severe disease or died within 12 hours of being admitted. Of
the 302 patients in the study who developed severe disease or died,
the median time of disease progression was 1.1 days.



========================================================================== "Rapid progression of disease following admission [to the hospital]
provides a narrow window to intervene," Garibaldi writes in the
article. "Different combinations of risk factors appear to predict
severe disease or death, with probabilities ranging from over 90%
to as little as 5%." For example, using the CIRC, Garibaldi and his
colleagues estimate that a 60- year-old white woman with a BMI of 28,
no chronic disease and no fever who is hospitalized for COVID-19 has a
10% chance of her disease worsening by day two of her hospital stay. The
longer she's in the hospital, the greater that chance becomes, at 15%
after four days and 16% after a week.

Conversely, the researchers considered an 81-year-old Black woman admitted
to the hospital with COVID-19. The hypothetical patient has a BMI of 35, diabetes, hypertension and a fever. CIRC forecasts her probability of progressing to severe disease or even death by just the second day of
her hospital stay is 89%. That percentage increases to higher than 95%
by days four and seven.

By June 24, 694 of the patients in the study had been discharged from
the hospital, 131 had died and seven were still hospitalized with severe COVID-19.

"We identified a few readily measurable demographic and clinical
factors that, when assessed on admission to the hospital, can predict
if someone has a 5% or a 90% risk of developing severe disease or dying
from COVID-19," says Amita Gupta, M.D., professor of medicine at the
Johns Hopkins University School of Medicine, who directs the Center for Clinical Global Health Education and is a co-author of the study. "This is incredibly useful information to have when communicating with patients
and their families, as well as for informing resource allocation in
the hospital." The study's data comes from a registry of all patients
treated for the novel coronavirus infection at hospitals in the Johns
Hopkins system. Known as "JH- CROWN," the registry -- which is funded
by InHealth, the institution's precision medicine initiative -- offers demographics, diagnoses, procedures, social histories and other data
points relevant to caring for COVID-19 patients.

"The JH-CROWN data registry embodies the same teamwork and dedication
that went into the care of more than 3,000 COVID-19 patients admitted
to Johns Hopkins hospitals since the start of the pandemic," Garibaldi
says. "We hope it can teach us more about the nature of COVID-19 and
improve both patient care and research as we prepare for a second wave
of infections in the fall." A co-author of the study, Johns Hopkins
University Bloomberg School of Public Health biostatistics professor
Scott Zeger, Ph.D., calls JH-CROWN "part of a transformation of Johns
Hopkins Medicine into a learning health care system," where data provides real-time analytics that help doctors, nurses and other health care professionals zero in on precision care for each patient.


========================================================================== Story Source: Materials provided by Johns_Hopkins_Medicine. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Brian T. Garibaldi, Jacob Fiksel, John Muschelli, Matthew
L. Robinson,
Masoud Rouhizadeh, Jamie Perin, Grant Schumock, Paul Nagy,
Josh H. Gray, Harsha Malapati, Mariam Ghobadi-Krueger, Timothy
M. Niessen, Bo Soo Kim, Peter M. Hill, M. Shafeeq Ahmed, Eric
D. Dobkin, Renee Blanding, Jennifer Abele, Bonnie Woods, Kenneth
Harkness, David R. Thiemann, Mary G.

Bowring, Aalok B. Shah, Mei-Cheng Wang, Karen Bandeen-Roche, Antony
Rosen, Scott L. Zeger, Amita Gupta. Patient Trajectories Among
Persons Hospitalized for COVID-19. Annals of Internal Medicine,
2020; DOI: 10.7326/M20-3905 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/09/200922172624.htm

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