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.
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Early prediction of level-of-care requirements in patients with COVID-19
eLife 9:e60519.
https://doi.org/10.7554/eLife.60519
Further reading
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- 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.
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- Medicine
- Neuroscience
Background:
Subarachnoid hemorrhage (SAH) is characterized by intense central inflammation, leading to substantial post-hemorrhagic complications such as vasospasm and delayed cerebral ischemia. Given the anti-inflammatory effect of transcutaneous auricular vagus nerve stimulation (taVNS) and its ability to promote brain plasticity, taVNS has emerged as a promising therapeutic option for SAH patients. However, the effects of taVNS on cardiovascular dynamics in critically ill patients, like those with SAH, have not yet been investigated. Given the association between cardiac complications and elevated risk of poor clinical outcomes after SAH, it is essential to characterize the cardiovascular effects of taVNS to ensure this approach is safe in this fragile population. Therefore, this study assessed the impact of both acute and repetitive taVNS on cardiovascular function.
Methods:
In this randomized clinical trial, 24 SAH patients were assigned to either a taVNS treatment or a sham treatment group. During their stay in the intensive care unit, we monitored patient electrocardiogram readings and vital signs. We compared long-term changes in heart rate, heart rate variability (HRV), QT interval, and blood pressure between the two groups. Additionally, we assessed the effects of acute taVNS by comparing cardiovascular metrics before, during, and after the intervention. We also explored acute cardiovascular biomarkers in patients exhibiting clinical improvement.
Results:
We found that repetitive taVNS did not significantly alter heart rate, QT interval, blood pressure, or intracranial pressure (ICP). However, repetitive taVNS increased overall HRV and parasympathetic activity compared to the sham treatment. The increase in parasympathetic activity was most pronounced from 2 to 4 days after initial treatment (Cohen’s d = 0.50). Acutely, taVNS increased heart rate, blood pressure, and peripheral perfusion index without affecting the corrected QT interval, ICP, or HRV. The acute post-treatment elevation in heart rate was more pronounced in patients who experienced a decrease of more than one point in their modified Rankin Score at the time of discharge.
Conclusions:
Our study found that taVNS treatment did not induce adverse cardiovascular effects, such as bradycardia or QT prolongation, supporting its development as a safe immunomodulatory treatment approach for SAH patients. The observed acute increase in heart rate after taVNS treatment may serve as a biomarker for SAH patients who could derive greater benefit from this treatment.
Funding:
The American Association of Neurological Surgeons (ALH), The Aneurysm and AVM Foundation (ALH), The National Institutes of Health R01-EB026439, P41-EB018783, U24-NS109103, R21-NS128307 (ECL, PB), McDonnell Center for Systems Neuroscience (ECL, PB), and Fondazione Neurone (PB).
Clinical trial number:
