ACP risk grade: a simple mortality index for patients with confirmed or suspected COVID-19
ACP risk grade: a simple mortality index for patients with confirmed or suspected severe acute respiratory syndrome coronavirus 2 disease (COVID-19) during the early stage of outbreak in Wuhan, China.
Research authors: Lu J, Hu S, Fan R, Liu Z, Yin X, Wang Q, Lv Q, Cai Z, Li H, Hu Y, Han Y, Hu H, Gao W, Feng S, Liu Q, Li H, Sun J, Peng J, Yi X, Zhou Z, Guo Y, Hou J.
Details Formula Study characteristics Files & References
★★
Model author
Model ID
2119
Version
1.18
Revision date
2020-04-13
MeSH terms
  • Coronavirus, SARS
  • Clinical Prediction Rule
  • Prognosis
  • Model type
    Custom model (Conditional)
    Status
    public
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    Condition Formula

    Additional information

    Methods: In this retrospective one-centre cohort study, we included all the confirmed or suspected COVID-19 patients hospitalized in a COVID-19-designated hospital from January 21 to February 5, 2020. Demographic, clinical, laboratory, radiological and clinical outcome data were collected from the hospital information system, nursing records and laboratory reports.

    Results: Of 577 patients with at least one post-admission evaluation, the median age was 55 years (interquartile range [IQR], 39 - 66); 254 (44.0%) were men; 22.8% (100/438) were severe pneumonia on admission, and 37.7% (75/199) patients were SARS-CoV-2 positive. The clinical, laboratory and radiological data were comparable between positive and negative SARS-CoV-2 patients. During a median follow-up of 8.4 days (IQR, 5.8 - 12.0), 39 patients died with a 12-day cumulative mortality of 8.7% (95% CI, 5.9% to 11.5%). A simple mortality risk index (called ACP index), composed of Age and C-reactive Protein, was developed. By applying the ACP index, patients were categorized into three grades. The 12-day cumulative mortality in grade three (age ≥ 60 years and CRP ≥ 34 mg/L) was 33.2% (95% CI, 19.8% to 44.3%), which was significantly higher than those of grade two (age ≥ 60 years and CRP < 34 mg/L; age < 60 years and CRP ≥ 34 mg/L; 5.6% [95% CI, 0 to 11.3%]) and grade one (age < 60 years and CRP < 34 mg/L, 0%) (P <0.001), respectively.

    Source: 
    Lu J, Uh S, Fan R, Liu Z, Yin x et al. ACP risk grade: a simple mortality index for patients with confirmed or suspected severe acute respiratory syndrome coronavirus 2 disease (COVID-19) during the early stage of outbreak in Wuhan, China (Preprint). 
     

    Study Population

    Total population size: 577
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Continuous characteristics

    Name LL Q1 Median Q3 UL Unit
    Age 39 55 66 years
    C-reactive protein 8.2 26.5 36.7 mg/L

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Co-morbidities Hypertension 97
    Diabetes mellitus 43
    Cardiovascular disease 33
    Chronic liver disease 20
    COPD 6
    Stroke history 5
    ACP risk grade: a simple mortality index for patients with confirmed or suspected COVID-19
    V-1.18-2119.20.04.13
    Refer to Intended Use for instructions before use
    Evidencio B.V., Irenesingel 19, 7481 GJ, Haaksbergen, the Netherlands

    Predicted probability of 12-day COVID-19 mortality:
    ...
    %

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    Result
    Note
    Notes are only visible in the result download and will not be saved by Evidencio

    Predicted probability of 12-day COVID-19 mortality: %

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    Outcome stratification

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    Conditional information

    Result interpretation

    Intended use: 
    The ACP index provides an efficient, feasible and accessible approach to establish a hierarchical management system of COVID-19 in the SARS-CoV-2 highly endemic areas where medical resources are extremely limited. It is projected that this approach would benefit a considerable number of patients with COVID-19 by directing the medical resources appropriate for the severity of the disease, and thus reduce the mortality and save the socioeconomic resources.

    Background information:
    By multivariate cox regression analysis (with back selection), it is found that only patients’ age (hazard ratio [HR], 7.0; 95% CI, 2.1 - 23.5; P =0.002) and elevated CRP (HR, 13.5; 95% CI, 3.1 - 58.0; P <0.001) were independently significant in predicting the 12-day mortality risk. Based upon this observation, ACP index named after the Age and C-reactive Protein was developed to stratify the mortality risk of patients with COVID-19.

    Source: 
    Lu J, Uh S, Fan R, Liu Z, Yin x et al. ACP risk grade: a simple mortality index for patients with confirmed or suspected severe acute respiratory syndrome coronavirus 2 disease (COVID-19) during the early stage of outbreak in Wuhan, China (Preprint). 
     

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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