Derivation and validation of a prognostic model for predicting in-hospital mortality in patients admitted with COVID-19 in Wuhan, China: the PLANS (platelet lymphocyte age neutrophil sex) model
Background Previous published prognostic models for COVID-19 patients have been suggested to be prone to bias due to unrepresentativeness of patient population, lack of external validation, inappropriate statistical analyses, or poor reporting. A high-quality and easy-to-use prognostic model to predict in-hospital mortality for COVID-19 patients could support physicians to make better clinical decisions. Methods Fine-Gray models were used to derive a prognostic model to predict in-hospital mortality (treating discharged alive from hospital as the competing event) in COVID-19 patients using two retrospective cohorts (n = 1008) in Wuhan, China from January 1 to February 10, 2020. The proposed model was internally evaluated by bootstrap approach and externally evaluated in an external cohort (n = 1031). Results The derivation cohort was a case-mix of mild-to-severe hospitalized COVID-19 patients (43.6% females, median age 55). The final model (PLANS), including five predictor variables of platelet count, lymphocyte count, age, neutrophil count, and sex, had an excellent predictive performance (optimism-adjusted C-index: 0.85, 95% CI: 0.83 to 0.87; averaged calibration slope: 0.95, 95% CI: 0.82 to 1.08). Internal validation showed little overfitting. External validation using an independent cohort (47.8% female, median age 63) demonstrated excellent predictive performance (C-index: 0.87, 95% CI: 0.85 to 0.89; calibration slope: 1.02, 95% CI: 0.92 to 1.12). The averaged predicted cumulative incidence curves were close to the observed cumulative incidence curves in patients with different risk profiles. Conclusions The PLANS model based on five routinely collected predictors would assist clinicians in better triaging patients and allocating healthcare resources to reduce COVID-19 fatality.
基金:
National Nature Science Foundation of China [81870062, 81900038, 82073570, 11871164]; COVID-19 Emergency Response Project of Wuhan Science and Technology Department [2020020201010018]; National Key R&D Program of China [2017YFE0103400]
第一作者单位:[1]Shanghai Jiao Tong Univ, MOE Shanghai Key Lab Childrens Environm Hlth, Sch Med, Xin Hua Hosp, Shanghai, Peoples R China
通讯作者:
通讯机构:[8]Fudan Univ, Sch Publ Hlth, Dept Biostat, Minist Educ, Shanghai, Peoples R China[9]Fudan Univ, Key Lab Publ Hlth Safety, Minist Educ, Shanghai, Peoples R China
推荐引用方式(GB/T 7714):
Li Jiong,Chen Yuntao,Chen Shujing,et al.Derivation and validation of a prognostic model for predicting in-hospital mortality in patients admitted with COVID-19 in Wuhan, China: the PLANS (platelet lymphocyte age neutrophil sex) model[J].BMC INFECTIOUS DISEASES.2020,20(1):doi:10.1186/s12879-020-05688-y.
APA:
Li, Jiong,Chen, Yuntao,Chen, Shujing,Wang, Sihua,Zhang, Dingyu...&Yu, Yongfu.(2020).Derivation and validation of a prognostic model for predicting in-hospital mortality in patients admitted with COVID-19 in Wuhan, China: the PLANS (platelet lymphocyte age neutrophil sex) model.BMC INFECTIOUS DISEASES,20,(1)
MLA:
Li, Jiong,et al."Derivation and validation of a prognostic model for predicting in-hospital mortality in patients admitted with COVID-19 in Wuhan, China: the PLANS (platelet lymphocyte age neutrophil sex) model".BMC INFECTIOUS DISEASES 20..1(2020)