A Simplified Comorbidity Evaluation Predicting Clinical Outcomes Among Patients With Coronavirus Disease 2019

Jessica J Kirby; Sajid Shaikh; David P Bryant; Amy F Ho; James P d'Etienne; Chet D Schrader; Hao Wang

doi:10.14740/jocmr4476

A Simplified Comorbidity Evaluation Predicting Clinical Outcomes Among Patients With Coronavirus Disease 2019

J Clin Med Res. 2021 Apr;13(4):237-244. doi: 10.14740/jocmr4476. Epub 2021 Apr 27.

Authors

Jessica J Kirby^{1

2}, Sajid Shaikh^{3

2}, David P Bryant¹, Amy F Ho¹, James P d'Etienne¹, Chet D Schrader¹, Hao Wang¹

Affiliations

¹ Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
² These authors contributed equally to this article.
³ Department of Information Technology, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.

Abstract

Background: Patients with coronavirus disease 2019 (COVID-19) have shown a range of clinical outcomes. Previous studies have reported that patient comorbidities are predictive of worse clinical outcomes, especially when patients have multiple chronic diseases. We aim to: 1) derive a simplified comorbidity evaluation and determine its accuracy of predicting clinical outcomes (i.e., hospital admission, intensive care unit (ICU) admission, ventilation, and in-hospital mortality); and 2) determine its performance accuracy in comparison to well-established comorbidity indexes.

Methods: This was a single-center retrospective observational study. We enrolled all emergency department (ED) patients with COVID-19 from March 1, 2020, to December 31, 2020. A simplified comorbidity evaluation (COVID-related high-risk chronic condition (CCC)) was derived to predict different clinical outcomes using multivariate logistic regressions. In addition, chronic diseases included in the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) were scored, and its accuracy of predicting COVID-19 clinical outcomes was also compared with the CCC.

Results: Data were retrieved from 90,549 ED patient visits during the study period, among which 3,864 patients were COVID-19 positive. Forty-seven point nine percent (1,851/3,864) were admitted to the hospital, 9.4% (364) patients were admitted to the ICU, 6.2% (238) received invasive mechanical ventilation, and 4.6% (177) patients died in the hospital. The CCC evaluation correlated well with the four studied clinical outcomes. The adjusted odds ratios of predicting in-hospital death from CCC was 2.84 (95% confidence interval (CI): 1.81 - 4.45, P < 0.001). C-statistics of CCC predicting in-hospital all-cause mortality was 0.73 (0.69 - 0.76), similar to those of the CCI's (0.72) and ECI's (0.71, P = 0.0513).

Conclusions: CCC can accurately predict clinical outcomes among patients with COVID-19. Its performance accuracies for such predictions are not inferior to those of the CCI or ECI's.

Keywords: COVID-19; Clinical outcome; Comorbidity.