ABSTRACT
Objective
To develop a predictive model for COPD patients admitted for COVID-19 to support clinical decision-making.
Method
Retrospective cohort study of 1313 COPD 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 characteristics, baseline comorbidities, baseline treatments, and other background data. Multivariable logistic regression analysis was used to develop the predictive model.
Results
Male sex, older age, hospital admissions in the previous year, flu vaccination in the previous season, a Charlson Index>3 and a prescription of renin-angiotensin aldosterone system inhibitors at baseline were the main risk factors for hospital admission. The AUC of the categorized risk score was 0.72 and 0.69 in the derivation and validation samples, respectively. Based on the risk score, four groups were identified with a risk of hospital admission ranging from 21% to 80%.
Conclusions
We propose a classification system to identify COPD people with COVID-19 with a higher risk of hospitalization, and indirectly, more severe disease, that is easy to use in primary care, as well as hospital emergency room settings to help clinical decision-making.
ClinicalTrials.gov Identifier
NCT04463706
Article highlights
Older age and male sex are two common key factors in COVID-19 poor prognosis
Previous hospitalizations for any medical cause, comorbidities, seasonal flu vaccination and baseline prescriptions of renin-angiotensin aldosterone system inhibitors at baseline were added predictors of hospitalization in COPD patients
We develop a risk score that may help to guide in the clinical decision making process
Risk of hospitalization in COPD patients is relatively high even for low scores
Acknowledgments
We are grateful for the support of the Basque Health Service-Osakidetza and the Department of Health of the Basque Government. We also gratefully acknowledge the patients who participated in the study. The authors also would like to thank Ideas Need Communicating Language Services for improving the use of English in the manuscript.
Declaration of interests
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contributions
Desing of the study: C. Esteban, J.M. Quintana, S. García-Gutierrez.
Analysis of the data: A. Villanueva, J.M. Quintana, S. García-Gutierrez.
Interpretation of the results: C. Esteban, J.M. Quintana, A. Aramburu, IG, S. García-Gutierrez, A. Villanueva.
Acquisition of data: A. Villanueva, S. García-Gutierrez, A. Aramburu. IG
Drafting: C. Esteban, J.M. Quintana, A. Villanueva.
All authors have read and approved the final manuscript.
Conflicts of interest
The authors declare that they have no conflict of interest.
Ethics approval
The study protocol was approved by the Ethics Committee of the Basque Country (reference PI2020059).