Modelling the risk of hospital admission of lab confirmed SARS-CoV-2-infected patients in primary care: a population-based study

Internal and Emergency Medicine - Tập 17 - Trang 1211-1221 - 2022
Janire Portuondo-Jimenez1,2,3, Amaia Bilbao-González4,5,6, Verónica Tíscar-González3,4,7, Ignacio Garitano-Gutiérrez8,9, Susana García-Gutiérrez5,6,10, Almudena Martínez-Mejuto3,11, Jaione Santiago-Garin8,7, Silvia Arribas-García8,7, Julia García-Asensio1, Johnny Chart-Pascual12, Iñaki Zorrilla-Martínez13,12,14, Jose Maria Quintana-Lopez5,6,10
1Basque Government Department of Health, Office of Healthcare Planning, Organisation and Evaluation, Basque Country, Spain
2Osakidetza Basque Health Service, Sub-Directorate for Primary Care Coordination, Vitoria-Gasteiz, Spain
3Biocruces Bizkaia Health Research Institute, Clinical Nursing and Community Health Group, Barakaldo, Spain
4Osakidetza Basque Health Service, Basurto University Hospital, Research Unit, Bilbao, Spain
5Health Service Research Network On Chronic Diseases (REDISSEC), Bilbao, Spain
6Kronikgune Institute for Health Services Research, Barakaldo, Spain
7Osakidetza Basque Health Service, University School of Nursing, University of the Basque Country, Vitoria-Gasteiz, Spain
8Bioaraba Health Research Institute, Clinical Nursing and Community Health Group, Vitoria-Gasteiz, Spain
9Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
10Osakidetza Basque Health Service, Galdakao-Usansolo University Hospital, Research Unit, Galdakao, Spain
11Osakidetza Basque Health Service, Cruces University Hospital, Barakaldo, Spain
12Osakidetza Basque Health Service, Araba IHO, Psychiatry Service, Vitoria-Gasteiz, Spain
13Bioaraba Health Research Institute, Clinical trials, Vitoria-Gasteiz, Spain
14Faculty of Medicine, University of the Basque Country, Vitoria-Gasteiz, Spain

Tóm tắt

The objectives of this study are to develop a predictive model of hospital admission for COVID-19 to help in the activation of emergency services, early referrals from primary care, and the improvement of clinical decision-making in emergency room services. The method is the retrospective cohort study of 49,750 patients with microbiological confirmation of SARS-CoV-2 infection. The sample was randomly divided into two subsamples, for the purposes of derivation and validation of the prediction rule (60% and 40%, respectively). Data collected for this study included sociodemographic data, baseline comorbidities, baseline treatments, and other background data. Multilevel analyses with generalized estimated equations were used to develop the predictive model. Male sex and the gradual effect of age were the main risk factors for hospital admission. Regarding baseline comorbidities, coagulopathies, cancer, cardiovascular diseases, diabetes with organ damage, and liver disease were among the five most notable. Flu vaccination was a risk factor for hospital admission. Drugs that increased risk were chronic systemic steroids, immunosuppressants, angiotensin-converting enzyme inhibitors, and NSAIDs. The AUC of the risk score was 0.821 and 0.828 in the derivation and validation samples, respectively. Based on the risk score, five risk groups were derived with hospital admission ranging from 2.94 to 51.87%. In conclusion, we propose a classification system for people with COVID-19 with a higher risk of hospitalization, and indirectly with it a greater severity of the disease, easy to be completed both in primary care, as well as in emergency services and in hospital emergency room to help in clinical decision-making. Registration: ClinicalTrials.gov Identifier: NCT04463706.

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