Development of a predictive prognostic rule for early assessment of COVID-19 patients in primary care settings

摘要

ObjectiveTo investigate possible early prognostic factors among middle-aged and older adult and explore prognostic rules stratifying risk of patients.DesignCommunity-based retrospective cohort.SettingPrimary Health Care Tarragona region.Participants282 community-dwelling symptomatic patients ≥50 years with laboratory-confirmed COVID-19 (hospitalised and/or outpatient) during March-June 2020 in Tarragona (Southern Catalonia, Spain).Main outcome measurementsRelationship between demographics, pre-existing comorbidities and early symptomatology (first 5-days) and risk of suffering critical outcome (ICU-admission/death) across clinical course was evaluated by logistic regression analyses, and simple predictive models were developed.ResultsOf the 282 cases (mean age: 65.9 years; 140 men), 154 (54.6%) were hospitalised (30 ICU-admitted) and 45 (16%) deceased. Median time follow-up in clinical course was 31 days (range: 30–150) for survivors and 14 days (range: 1–81) for deceased patients. In crude analyses, increasing age, male sex, some comorbidities (renal, respiratory or cardiac disease, diabetes and hypertension) and symptoms (confusion, dyspnoea) were associated with an increased risk to suffer critical outcome, whereas other symptoms (rinorrhea, myalgias, headache, anosmia/disgeusia) were related with reduced risk. After multivariable-adjustment only age/years (OR: 1.04; 95% CI: 1.01–1.07;p=0.004), confusion (OR: 5.33; 95% CI: 1.54–18.48;p=0.008), dyspnoea (OR: 5.41; 95% CI: 2.74–10.69;p<0.001) and myalgias (OR: 0.30; 95% CI: 0.10–0.93;p=0.038) remained significantly associated with increased or reduced risk. A proposed CD65-M prognostic rule (acronym of above mentioned 4 variables) showed a good correlation with the risk of suffering critical outcome (area under ROC curve: 0.828; 95% CI: 0.774–0.882).ConclusionClinical course of COVID-19 is early unpredictable, but simple clinical tools as the proposed CD65-M rule (pending external validation) may be helpful assessing these patients in primary care settings.