Early prediction of level-of-care requirements in patients with COVID-19
- Boston University, United States
- Massachusetts General Hospital, Harvard Medical School, United States
Abstract
This study examined records of 2,566 consecutive COVID-19 patients at five Massachusetts hospitals and sought to predict level-of-care requirements based on clinical and laboratory data. Several classification methods were applied and compared against standard pneumonia severity scores. The need for hospitalization, ICU care, and mechanical ventilation were predicted with a validation accuracy of 88%, 87%, and 86%, respectively.ICU care and ventilation. When predictions are limited to patients with more complex disease, the accuracy of the ICU and ventilation prediction models achieved accuracy of 83% and 82%, respectively. Vital signs, age, BMI, dyspnea, and comorbidities were the most important predictors of hospitalization. Opacities on chest imaging, age, admission vital signs and symptoms, male gender, admission laboratory results, and diabetes were the most important risk factors for ICU admission and mechanical ventilation. The factors identified collectively form a signature of the novel COVID-19 disease.
Data availability
- Source code for processing patient data is provided together with the submission.- Due to HIPAA restrictions and Data Use Agreements we can not make the original patient data publicly available. Interested parties may submit a request to obtain access to de-identified data to the authors. The authors would request pertinent IRB approval to make available a de-identified version of the data, stripped of any protected health information as specified under HIPAA rules.-The IRB of the hospital system approved the study under Protocol #2020P001112 and the Boston University IRB found the study as being Not Human Subject Research under Protocol #5570X (the BU team worked with a de-identified limited dataset).
Article and author information
Author details
Shahabeddin Sotudian
Ioannis Ch Paschalidis
Funding
National Science Foundation (IIS-1914792)
- Ioannis Ch Paschalidis
National Science Foundation (DMS-1664644)
- Ioannis Ch Paschalidis
National Science Foundation (CNS-1645681)
- Ioannis Ch Paschalidis
National Institute of General Medical Sciences (R01 GM135930)
- Ioannis Ch Paschalidis
Office of Naval Research (N00014-19-1-2571)
- Ioannis Ch Paschalidis
National Institutes of Health (UL54 TR004130)
- Ioannis Ch Paschalidis
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Ethics
Human subjects: The Institutional Review Board of Mass General Brigham reviewed and approved the study under Protocol #2020P001112. The Boston University IRB found the study as being Not Human Subject Research under Protocol #5570X (the BU team worked with a de-identified limited dataset).
Copyright
© 2020, Hao et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
Metrics
-
- 3,235
- views
-
- 291
- downloads
-
- 48
- citations
Views, downloads and citations are aggregated across all versions of this paper published by eLife.
Download links
A two-part list of links to download the article, or parts of the article, in various formats.
Downloads (link to download the article as PDF)
Open citations (links to open the citations from this article in various online reference manager services)
Cite this article (links to download the citations from this article in formats compatible with various reference manager tools)
Early prediction of level-of-care requirements in patients with COVID-19
eLife 9:e60519.
https://doi.org/10.7554/eLife.60519
Further reading
-
- Medicine
- Microbiology and Infectious Disease
- Epidemiology and Global Health
- Immunology and Inflammation
eLife has published articles on a wide range of infectious diseases, including COVID-19, influenza, tuberculosis, HIV/AIDS, malaria and typhoid fever.
-
- Medicine
- Neuroscience
The advent of midazolam holds profound implications for modern clinical practice. The hypnotic and sedative effects of midazolam afford it broad clinical applicability. However, the specific mechanisms underlying the modulation of altered consciousness by midazolam remain elusive. Herein, using pharmacology, optogenetics, chemogenetics, fiber photometry, and gene knockdown, this in vivo research revealed the role of locus coeruleus (LC)-ventrolateral preoptic nucleus noradrenergic neural circuit in regulating midazolam-induced altered consciousness. This effect was mediated by α1 adrenergic receptors. Moreover, gamma-aminobutyric acid receptor type A (GABAA-R) represents a mechanistically crucial binding site in the LC for midazolam. These findings will provide novel insights into the neural circuit mechanisms underlying the recovery of consciousness after midazolam administration and will help guide the timing of clinical dosing and propose effective intervention targets for timely recovery from midazolam-induced loss of consciousness.
