Conventional risk prediction models fail to accurately predict mortality risk among patients with coronavirus disease 2019 in intensive care units: a difficult time to assess clinical severity and quality of care

Hideki Endo; Hiroyuki Ohbe; Junji Kumasawa; Shigehiko Uchino; Satoru Hashimoto; Yoshitaka Aoki; Takehiko Asaga; Eiji Hashiba; Junji Hatakeyama; Katsura Hayakawa; Nao Ichihara; Hiromasa Irie; Tatsuya Kawasaki; Hiroshi Kurosawa; Tomoyuki Nakamura; Hiroshi Okamoto; Hidenobu Shigemitsu; Shunsuke Takaki; Kohei Takimoto; Masatoshi Uchida; Ryo Uchimido; Hiroaki Miyata

doi:10.1186/s40560-021-00557-5

Conventional risk prediction models fail to accurately predict mortality risk among patients with coronavirus disease 2019 in intensive care units: a difficult time to assess clinical severity and quality of care

J Intensive Care. 2021 Jun 1;9(1):42. doi: 10.1186/s40560-021-00557-5.

Authors

Hideki Endo^{1

2}, Hiroyuki Ohbe³, Junji Kumasawa⁴, Shigehiko Uchino⁵, Satoru Hashimoto⁶, Yoshitaka Aoki⁷, Takehiko Asaga⁸, Eiji Hashiba⁹, Junji Hatakeyama¹⁰, Katsura Hayakawa¹¹, Nao Ichihara¹², Hiromasa Irie¹³, Tatsuya Kawasaki¹⁴, Hiroshi Kurosawa¹⁵, Tomoyuki Nakamura¹⁶, Hiroshi Okamoto¹⁷, Hidenobu Shigemitsu¹⁸, Shunsuke Takaki¹⁹, Kohei Takimoto²⁰, Masatoshi Uchida²¹, Ryo Uchimido¹⁸, Hiroaki Miyata²²

Affiliations

¹ Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. hidendo-thk@umin.ac.jp.
² Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. hidendo-thk@umin.ac.jp.
³ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
⁴ Department of Critical Care Medicine, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku, Sakai, Osaka, 593-8304, Japan.
⁵ Intensive Care Unit, The Jikei University School of Medicine, 3-19-18 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8471, Japan.
⁶ Department of Anesthesiology and Intensive Care Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
⁷ Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
⁸ Intensive Care Unit, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
⁹ Division of Intensive Care, Hirosaki University Hospital, 53 Honcho, Hirosaki, Aomori, 036-8203, Japan.
¹⁰ Department of Emergency and Critical Care Medicine, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
¹¹ Department of Emergency and Critical Care Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan.
¹² Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
¹³ Department of Anesthesiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
¹⁴ Department of Pediatric Critical Care, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, Shizuoka, 420-8660, Japan.
¹⁵ Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
¹⁶ Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
¹⁷ Department of Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
¹⁸ Department of Intensive Care Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
¹⁹ Department of Anesthesiology and Critical Care Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
²⁰ Department of Intensive Care Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan.
²¹ Department of Emergency and Critical Care Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan.
²² Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.

Abstract

Since the start of the coronavirus disease 2019 (COVID-19) pandemic, it has remained unknown whether conventional risk prediction tools used in intensive care units are applicable to patients with COVID-19. Therefore, we assessed the performance of established risk prediction models using the Japanese Intensive Care database. Discrimination and calibration of the models were poor. Revised risk prediction models are needed to assess the clinical severity of COVID-19 patients and monitor healthcare quality in ICUs overwhelmed by patients with COVID-19.

Keywords: Coronavirus disease 2019; Intensive care unit; Quality improvement; Risk of death; Risk prediction model.

Publication types

Letter