Non-applicability of a validated predictive model for intensive care admission and death of COVID-19 patients in a secondary care hospital in Belgium

Abstract

Background: Simple and reliable predictive scores for intensive care admissions and death based on clinical data in coronavirus disease 2019 (COVID-19) patients are numerous but may be misleading. Predictive scores for admission to intensive care unit (ICU) or death based on clinical and easily affordable laboratory data are still needed in secondary hospital and hospitals in developing countries that do not have high-performance laboratories. Methods: The goal of this study is to verify that a recently published predictive score conducted on a large scale in China (Liang score) can be used on patients coming from a Belgian population catchment area. Monocentric retrospective cohort study of 66 patients with known COVID-19 disease run from early March to end of May in Clinique Saint-Pierre Ottignies, a secondary care hospital in Belgium. The outcomes of the study are (I) admission in the ICU and (II) death. All patients admitted in the Emergency Department with a positive RT-PCR SARS-CoV-2 test were included in the study. Routine clinical and laboratory data were collected at their admission and during their stay, as well as chest X-rays and CT-scans. Liang score was used as benchmark. Logistic regression models were used to develop predictive. Results: Liang score performs poorly, both in terms of admission to intensive care and in terms of death. In our cohort, it appears that lactate dehydrogenase (LDH) above 579 UI/L and venous lactate above 3.02 mmol/L may be considered as good predictive biological factors for ICU admission. With regards to death risk, neutrophil-lymphocyte ratio (NLR) above 22.1, tobacco abuse status and respiratory impairment appears to be relevant predictive factors. Conclusions: Firstly, a promising score from a large-scale study in China appears to perform poorly when applied to a European cohort, whether to predict for admission to ICU or death. Secondly, biological features that are quite significant for the admission to ICU such as LDH or venous lactate cannot predict death. Thirdly, simple and affordable variables such as LDH, LDH + sex, or LDH + sex + venous lactate have a very good sensitivity and an acceptable specificity for ICU admission. © Journal of Emergency and Critical Care Medicine. All rights reserved.