Comparison of in-hospital mortality risk prediction models from COVID-19.
Comparison of in-hospital mortality risk prediction models from COVID-19.
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DOI：
10.1371/journal.pone.0244629
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Mergenhagen KA
中科院分区：
文献类型：
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作者：
El-Solh AA;Lawson Y;Carter M;El-Solh DA;Mergenhagen KA
我们的目标是比较2020年1月1日至5月1日期间发表的2019年冠状病毒病（COVID-19）住院患者的四种最近建立的结局模型的预测准确性。我们使用2020年1月1日至2020年5月1日期间从退伍军人事务公司数据仓库（CDW）获得的数据作为外部验证队列。结局指标为住院死亡率。ROC曲线下面积（AUC）用于评估四种预测模型的区分度。Hosmer-Lemeshow（HL）拟合优度检验和校准曲线评估了模型对个体病例的适用性。在研究期间，确定了1634名独特的患者。研究队列的平均年龄为68.8±13.4岁。高血压、高脂血症和心脏病是最常见的合并症。粗住院死亡率为29%（95%置信区间[CI] 0.27-0.31）。预测模型的评价显示AUC范围为0.63（95% CI 0.60-0.66）至0.72（95% CI 0.69-0.74），表明所有模型的区分度一般至较差。四种预后系统的AUC值之间无显著差异。所有的模型都被高估或低估的医院死亡率校准得很差。本研究中检查的所有四种预后模型都预示着高风险偏倚。在COVID-19住院患者中，需要谨慎解释这些评分的表现。
Our objective is to compare the predictive accuracy of four recently established outcome models of patients hospitalized with coronavirus disease 2019 (COVID-19) published between January 1st and May 1st 2020. We used data obtained from the Veterans Affairs Corporate Data Warehouse (CDW) between January 1st, 2020, and May 1st 2020 as an external validation cohort. The outcome measure was hospital mortality. Areas under the ROC (AUC) curves were used to evaluate discrimination of the four predictive models. The Hosmer–Lemeshow (HL) goodness-of-fit test and calibration curves assessed applicability of the models to individual cases. During the study period, 1634 unique patients were identified. The mean age of the study cohort was 68.8±13.4 years. Hypertension, hyperlipidemia, and heart disease were the most common comorbidities. The crude hospital mortality was 29% (95% confidence interval [CI] 0.27–0.31). Evaluation of the predictive models showed an AUC range from 0.63 (95% CI 0.60–0.66) to 0.72 (95% CI 0.69–0.74) indicating fair to poor discrimination across all models. There were no significant differences among the AUC values of the four prognostic systems. All models calibrated poorly by either overestimated or underestimated hospital mortality. All the four prognostic models examined in this study portend high-risk bias. The performance of these scores needs to be interpreted with caution in hospitalized patients with COVID-19.
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影响因子：
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