Predicting Critical Illness Among Patients Hospitalized With COVID-19

A clinical risk assessment tool developed in China was tested with a group of patients in Spain to evaluate its ability to predict critical illness among patients hospitalized with COVID-19 in Europe.

Moreno-Pérez, et al. (2021) say that accurate risk-predicting tools are imperative for managing the COVID-19 pandemic with limited health resources. High COVID-GRAM scores at presentation could warrant increased vigilance and treatment, while low scores could require only observation. The COVID-GRAM was developed among patients with a 1.5% incidence of severe pneumonia, as defined by the American Thoracic Society, and an 8.2% incidence of critical illness. Thus, the COVID-GRAM score should be replicated and validated for use in other clinical populations.

The researchers retrospectively applied the COVID-GRAM tool to a cohort of patients with COVID-19 who were hospitalized from March 3 to May 2, 2020, in Alicante, Spain—a country with one of the most extensive outbreaks of SARS-CoV-2 in Europe. From the total cohort, they selected patients who (1) were eligible for intensive care and invasive mechanical ventilation, if needed (a major role of the COVID-GRAM would be to intensify treatment in patients at high risk of critical illness) and (2) had complete data for calculating their COVID-GRAM score. Similar to the outcome for the study that validated the COVID-GRAM tool in China, they defined critical illness as composed of admission to the ICU, invasive mechanical ventilation, or death.

Of the cohort of 306 patients hospitalized with COVID-19, intensive care was required for 236 (77.1%) patients of whom 214 (median [interquartile range] age, 60.5 [48.0-70.7] years; 86 [40.1%] women) had complete data. Patients with incomplete data were excluded but were similar to the study cohort in age, gender, degree of comorbidity (Charlson Comorbidity Index score), arterial hypertension, diabetes, obesity, extent of radiological involvement, use of tocilizumab, ICU admission, and need for invasive mechanical ventilation. Compared with the validation cohort in China, this study’s population was older (median age, 60.5 years vs 48.2 years) and had more comorbidities (54.6% vs 24.2% with ≥1 coexisting condition). With a median (interquartile range) follow-up of 43 (33-48) days, critical illness developed in 52 (21.8%) patients (40 admitted to the ICU, 35 required invasive mechanical ventilation, and 13 died) vs 12.3% in the Chinese validation cohort.

Reference: Moreno-Pérez O, et al. The COVID-GRAM Tool for Patients Hospitalized With COVID-19 in Europe. JAMA Intern Med. Published online April 5, 2021. doi:10.1001/jamainternmed.2021.0491

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