CAPRL Scoring System for Prediction of 30-day Mortality in 949 Patients with Coronavirus Disease 2019 in Wuhan, China: A Retrospective, Observational Study

Hui-Long Chen; Wei-Ming Yan; Guang Chen; Xiao-Yun Zhang; Zhi-Lin Zeng; Xiao-Jing Wang; Wei-Peng Qi; Min Wang; Wei-Na Li; Ke Ma; Dong Xu; Ming Ni; Jia-Quan Huang; Lin Zhu; Shen Zhang; Liang Chen; Hong-Wu Wang; Chen Ding; Xiao-Ping Zhang; Jia Chen; Hai-Jing Yu; Hong-Fang Ding; Liang Wu; Ming-You Xing; Jian-Xin Song; Tao Chen; Xiao-Ping Luo; Wei Guo; Mei-Fang Han; Di Wu; Qin Ning

doi:10.1097/ID9.0000000000000001

CAPRL Scoring System for Prediction of 30-day Mortality in 949 Patients with Coronavirus Disease 2019 in Wuhan, China: A Retrospective, Observational Study

Infect Dis Immun. 2021 Apr 20;1(1):28-35. doi: 10.1097/ID9.0000000000000001. eCollection 2021 Apr.

Authors

Hui-Long Chen¹, Wei-Ming Yan¹, Guang Chen¹, Xiao-Yun Zhang¹, Zhi-Lin Zeng¹, Xiao-Jing Wang¹, Wei-Peng Qi¹, Min Wang¹, Wei-Na Li¹, Ke Ma¹, Dong Xu¹, Ming Ni¹, Jia-Quan Huang¹, Lin Zhu¹, Shen Zhang¹, Liang Chen¹, Hong-Wu Wang¹, Chen Ding¹, Xiao-Ping Zhang¹, Jia Chen¹, Hai-Jing Yu¹, Hong-Fang Ding¹, Liang Wu¹, Ming-You Xing¹, Jian-Xin Song^{1

2}, Tao Chen¹, Xiao-Ping Luo², Wei Guo¹, Mei-Fang Han¹, Di Wu¹, Qin Ning¹

Affiliations

¹ Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
² Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a serious and even lethal respiratory illness. The mortality of critically ill patients with COVID-19, especially short term mortality, is considerable. It is crucial and urgent to develop risk models that can predict the mortality risks of patients with COVID-19 at an early stage, which is helpful to guide clinicians in making appropriate decisions and optimizing the allocation of hospital resoureces.

Methods: In this retrospective observational study, we enrolled 949 adult patients with laboratory-confirmed COVID-19 admitted to Tongji Hospital in Wuhan between January 28 and February 12, 2020. Demographic, clinical and laboratory data were collected and analyzed. A multivariable Cox proportional hazard regression analysis was performed to calculate hazard ratios and 95% confidence interval for assessing the risk factors for 30-day mortality.

Results: The 30-day mortality was 11.8% (112 of 949 patients). Forty-nine point nine percent (474) patients had one or more comorbidities, with hypertension being the most common (359 [37.8%] patients), followed by diabetes (169 [17.8%] patients) and coronary heart disease (89 [9.4%] patients). Age above 50 years, respiratory rate above 30 beats per minute, white blood cell count of more than10 × 10⁹/L, neutrophil count of more than 7 × 10⁹/L, lymphocyte count of less than 0.8 × 10⁹/L, platelet count of less than 100 × 10⁹/L, lactate dehydrogenase of more than 400 U/L and high-sensitivity C-reactive protein of more than 50 mg/L were independent risk factors associated with 30-day mortality in patients with COVID-19. A predictive CAPRL score was proposed integrating independent risk factors. The 30-day mortality were 0% (0 of 156), 1.8% (8 of 434), 12.9% (26 of 201), 43.0% (55 of 128), and 76.7% (23 of 30) for patients with 0, 1, 2, 3, ≥4 points, respectively.

Conclusions: We designed an easy-to-use clinically predictive tool for assessing 30-day mortality risk of COVID-19. It can accurately stratify hospitalized patients with COVID-19 into relevant risk categories and could provide guidance to make further clinical decisions.

Keywords: COVID-19; Mortality; Risk factor; SARS-CoV-2.