Novel calculators can help doctors predict patient outcomes and allocate better ICU beds and ventilators. VICE uncovers diabetes mellitus, oxygen saturation of the blood. DICE factors can predict coronary artery disease, diabetes, body mass index, platelet count, and a variety of inflammatory and infectious markers.
Two novel calculators help doctors predict which Covid-19 patients are at higher risk of requiring mechanical ventilation or death, reveals a new syudy developed and validated by Massachusetts General Hospital (MGH). In a study published in The Lancet's EClinicalMedicine, researchers describe how these models could enable clinicians to better stratify risk in COVID-infected patients to optimize care and resource utilization in hospitals faced with ICU capacity constraints.
‘Ventilation in COVID Estimate (VICE) uncovers factors like diabetes mellitus, oxygen saturation of the blood, and 2 inflammatory markers. Death in COVID Estimate (DICE) factors can predict coronary artery disease, diabetes mellitus, body mass index, platelet count, and a variety of inflammatory and infectious markers.’
"Information that can accurately predict severity of the clinical course at the time of hospital admission has been limited," says senior author Rajeev Malhotra, MD, a cardiologist at MGH and investigator in the MGH Cardiovascular Research Center. "Using a combination of past medical history, vital signs, and laboratory results at the time of patient admission, we developed models that can differentiate between risk for mechanical ventilation and risk for in-hospital mortality. While other studies have focused on 30-day hospital outcomes, we followed all COVID-19 patients to the end of their hospital course since a significant number are hospitalized well beyond 30 days."
The research team compiled this clinical information from 1,042 patients confirmed with COVID-19 who were admitted to five hospitals in the Mass General Brigham health care system during the first three months of the pandemic.
Significant associations between clinical, hemodynamic, and laboratory data and the endpoints of in-hospital mortality and mechanical ventilation provided the building blocks for two separate risk stratification models known as the VICE (Ventilation in COVID Estimate) and DICE (Death in COVID Estimate) scores.
Predictive VICE factors uncovered by researchers were diabetes mellitus, oxygen saturation of the blood, and two inflammatory markers: C-reactive protein and lactate dehydrogenase. DICE factors predictive of mortality were age, male sex, coronary artery disease, diabetes mellitus, body mass index, platelet count, and a variety of inflammatory and infectious markers.
Advertisement
Researchers were surprised to learn that age was not a significant predictor of whether a patient would require mechanical ventilation.
Advertisement
The study found that 59% of patients in the 25-to-34 age group required more than 14 days of ventilation, similar to older age groups.
"We were astonished to see the impact of this disease on young people admitted to the hospital," emphasizes Nicholson. "Our data showed they are just as likely to be put on a mechanical ventilator as older people, and to require a long duration of ventilation."
Another significant finding from the study was that regular use of statins was associated with reduced in-hospital mortality, underscoring the strong links among COVID-19, cardiovascular disease, and inflammation. In another encouraging finding, researchers did not observe any relationship between minority ethnic background of COVID-19 patients and worse clinical outcomes after adjusting for clinical risk.
"What we've generally learned from this disease is how different it is from any other we've seen in the ICU," says Malhotra, who has managed COVID patients in the cardiac intensive care unit at MGH over the past year. "For that reason, we were focused on developing a novel approach to evaluate and predict outcomes with our risk stratification calculator."
Source-Eurekalert