Development of laboratory-based risk scores to predict mortality in patients hospitalized with COVID-19OA
Objectives:Patient characteristics related to an increased risk of severe coronavirus disease 2019(COVID-19)have been thoroughly studied since the beginning of the pandemic;however,clinical tools offering rapid and automated predictions of patients’acute reactions to severe acute respiratory syndrome coronavirus 2(SARSCoV-2)infection remain limited.This study explored the associations between laboratory markers and mortality in hospitalized patients with COVID-19 and developed a scoring model using laboratory data to estimate patients’risk of mortality.--Methods:Participants were recruited from hospitals in the Greater Toronto Area between January 2020 and February 2022.Demographics,laboratory results,and treatment outcomes were collected from patient medical charts.Admission data for 33 biochemical and hematological markers assessing complete blood cell count,coagulation,general chemistry,inflammatory,liver,renal,and cardiac function were extracted for analyses.Results:Logistic regression revealed that 6 laboratory markers,including creatinine,sodium,bicarbonate,base excess,pH,and lactate,were significantly associated with COVID-19 patient mortality.Five markers were incorporated into a multivariable model after excluding correlated analytes.Low bicarbonate levels were the only significant finding in the multivariable model associated with increased odds of mortality.Receiver operating characteristic(ROC)curves including area under the curves(AUCs)revealed that risk scores constructed from multivariable values performed similarly to their univariable counterparts in both the training(0.82 vs 0.83)and validation(0.80 vs 0.80)cohorts.Overall,the risk score exhibited 80%accuracy in predicting mortality,with greater sensitivity than specificity.Conclusions:Developed risk scores provide moderate predictions of COVID-19 mortality,which could be improved by assessing larger populations.Additionally,significant markers from our cohort indicate that at-risk patients may present with acid‒base disruptions.
Mackenzie Scott;Olga Vishnyakova;Lloyd T.Elliott;Gregory Morgan;Selina Casalino;Erika Frangione;Elisa Lapadula;Simona Haller;Shilpa Thakur;Zeeshan Khan;Iris Wong;Romina Nomigolzar;Georgia MacDonald;Saranya Arnoldo;Erin Bearss;Alexandra Binnie;Bjug Borgundvaag;Luke Devine;David Richardson;Seth Stern;Ahmed Taher;Jordan Lerner-Ellis;Jennifer Taher
Lunenfeld-Tanenbaum Research Institute,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,Canada Pathology and Laboratory Medicine,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,Canada Department of Laboratory Medicine and Pathobiology,University of Toronto,Toronto M5S 1A8,Ontario,CanadaDepartment of Statistics and Actuarial Science,Simon Fraser University,Burnaby V5A 1S6,British Columbia,Canada Department of Biomedical Physiology and Kinesiology,Simon Fraser University,Burnaby V5A 1S6,British Columbia,Canada Canada’s Michael Smith Genome Sciences Centre,British Columbia Cancer,Vancouver V5Z 4S6,British Columbia,CanadaDepartment of Statistics and Actuarial Science,Simon Fraser University,Burnaby V5A 1S6,British Columbia,CanadaLunenfeld-Tanenbaum Research Institute,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,Canada Pathology and Laboratory Medicine,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,Canada Department of Laboratory Medicine and Pathobiology,University of Toronto,Toronto M5S 1A8,Ontario,CanadaLunenfeld-Tanenbaum Research Institute,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,Canada Pathology and Laboratory Medicine,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,CanadaLunenfeld-Tanenbaum Research Institute,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,Canada Pathology and Laboratory Medicine,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,CanadaLunenfeld-Tanenbaum Research Institute,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,Canada Pathology and Laboratory Medicine,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,CanadaLunenfeld-Tanenbaum Research Institute,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,Canada Pathology and Laboratory Medicine,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,CanadaLunenfeld-Tanenbaum Research Institute,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,Canada Pathology and Laboratory Medicine,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,CanadaDepartment of Emergency Medicine,Mackenzie Health,Richmond Hill L4C 4Z3,Ontario,CanadaDepartment of Post Anaesthetic Care,Mackenzie Health,Richmond Hill L4C 4Z3,Ontario,CanadaDepartment of Emergency Medicine,Mackenzie Health,Richmond Hill L4C 4Z3,Ontario,CanadaLunenfeld-Tanenbaum Research Institute,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,Canada Pathology and Laboratory Medicine,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,CanadaDepartment of Laboratory Medicine and Pathobiology,University of Toronto,Toronto M5S 1A8,Ontario,Canada Department of Laboratory Services,William Osler Health System,Brampton L6R 3J7,Ontario,CanadaMount Sinai Academic Family Health Team,Mount Sinai Hospital,Toronto M5T 3L9,Ontario,Canada Department of Family and Community Medicine,University of Toronto,Toronto M5G 1V7,Ontario,CanadaDepartment of Critical Care,William Osler Health System,Etobicoke M9V 1R8,Ontario,CanadaSchwartz/Reisman Emergency Medicine Institute,Sinai Health System,Toronto M5G 1X5,Ontario,CanadaDivision of General Internal Medicine,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,Canada Faculty of Medicine,University of Toronto,Toronto M5S 1A8,Ontario,CanadaDepartment of Laboratory Services,William Osler Health System,Brampton L6R 3J7,Ontario,CanadaDepartment of Medicine,Mackenzie Health,Richmond Hill L4C 4Z3,Ontario,CanadaDivision of Emergency Medicine,University of Toronto,Toronto M5S 1A8,Ontario,Canada Department of Emergency Medicine,Mackenzie Health,Vaughan L6A 4Z3,Ontario,CanadaLunenfeld-Tanenbaum Research Institute,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,Canada Pathology and Laboratory Medicine,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,Canada Department of Laboratory Medicine and Pathobiology,University of Toronto,Toronto M5S 1A8,Ontario,CanadaPathology and Laboratory Medicine,Mount Sinai Hospital,Toronto M5G 1X5,Ontario,Canada Department of Laboratory Medicine and Pathobiology,University of Toronto,Toronto M5S 1A8,Ontario,Canada
医药卫生
COVID-19Risk scoreBiochemistry markersMortalityAcid‒base disruption
《LabMed Discovery》 2025 (4)
P.23-35,13
funded by the International Federation of Clinical Chemistry(IFCC)Task Force for Outcome Studies on Laboratory Medicine(No.TF OSLM)by Canadian Institute for Health Research(CIHR)(Nos.VR4-172753,VS1-177526 and VS2-175572).
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