The PAINTS Score for Predicting Severe COVID-19: A Multi-Center Study in Zhejiang, China

Abstract

Background: To develop and validate a risk-scoring model for\xa0predicting\xa0severe COVID-19\xa0at presentation. \n \nMethods: Entire patients with COVID-19\xa0in\xa0three cities in Zhejiang, China\xa0from\xa0December 2019 to February 2020\xa0were analyzed retrospectively.\xa0The risk-scoring model was developed with nomogram using multivariate logistic regression and externally validated by the patients from two other cities near Wenzhou. \n \nFindings: Severe COVID-19 was detected 58 out of 488 (11·9%) eligible patients in the primary cohort and 24 out of 153 (15·7%) in the validation cohort. The sex (OR 4·11, 95% CI 1·38 to 14·05), body mass index >25 kg/m2 (OR 6·14, 95% CI 2·05 to 21·29), hypertension (OR 4·97, 95% CI 1·73 to 15·37), neutrophil/lymphocyte ratio (3-6) (OR 8·04, 95% CI 2·51 to 29·52), albumin (35-40) g/L (OR 37·96, 95% CI 5·49 to 825·34) and platelets >300×109/L (OR 6·76, 95% CI 1·55 to 32·47) were independent predictors of severe COVID-19. The risk-scoring model-PAINTS performed excellent discrimination with AUC 0·98, 95% CI 0·96 to 1·00 in the primary cohort and AUC 0·78 (95% CI, 0·67 to 0·89) in the validation cohort.\xa0Interpretation: PAINTS\xa0score\xa0may guide clinical decision-making efficiently and allocate limited medical resources reasonably. \xa0 \n \nFunding: The National Key New Drug Creation and Manufacturing Program, Ministry of Science and Technology (CN) [2020ZX09201002]; Wenzhou Science and Technology Key Problem Program [ZY2020001];\xa0The Primary Research and Development Plan of Zhejiang Province [2019C03011] and the Natural Science Foundation of Zhejiang Province [LQ20H150002]. \n \nDeclaration of Interest: None to declare. \n \nEthical Approval: The study was conducted under the amended Declaration of Helsinki and approved by the Institutional Review Board (IRB) of Wenzhou Medical University (No.2020-002). The written consent was waived by the Institutional Review Board (IRB) of Wenzhou Medical University (No.2020-002)