Prognosis models for severe and critical COVID-19 based on the Charlson and Elixhauser comorbidity indices

Int J Med Sci. 2020 Aug 25;17(15):2257-2263. doi: 10.7150/ijms.50007. eCollection 2020.

Abstract

Background: Corona Virus Disease 2019 (COVID-19) has become a global pandemic. This study established prognostic scoring models based on comorbidities and other clinical information for severe and critical patients with COVID-19. Material and Methods: We retrospectively collected data from 51 patients diagnosed as severe or critical COVID-19 who were admitted between January 29, 2020, and February 18, 2020. The Charlson (CCI), Elixhauser (ECI), and age- and smoking-adjusted Charlson (ASCCI) and Elixhauser (ASECI) comorbidity indices were used to evaluate the patient outcomes. Results: The mean hospital length of stay (LOS) of the COVID-19 patients was 22.82 ± 12.32 days; 19 patients (37.3%) were hospitalized for more than 24 days. Multivariate analysis identified older age (OR 1.064, P = 0.018, 95%CI 1.011-1.121) and smoking (OR 3.696, P = 0.080, 95%CI 0.856-15.955) as positive predictors of a long LOS. There were significant trends for increasing hospital LOS with increasing CCI, ASCCI, and ASECI scores (OR 57.500, P = 0.001, 95%CI 5.687-581.399; OR 71.500, P = 0.001, 95%CI 5.689-898.642; and OR 19.556, P = 0.001, 95%CI 3.315-115.372, respectively). The result was similar for the outcome of critical illness (OR 21.333, P = 0.001, 95%CI 3.565-127.672; OR 13.000, P = 0.009, 95%CI 1.921-87.990; OR 11.333, P = 0.008, 95%CI 1.859-69.080, respectively). Conclusions: This study established prognostic scoring models based on comorbidities and clinical information, which may help with the graded management of patients according to prognosis score and remind physicians to pay more attention to patients with high scores.

Keywords: Charlson comorbidity index; Corona Virus Disease; Elixhauser comorbidity index; comorbidity; length of stay; outcome.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Betacoronavirus / isolation & purification
  • Betacoronavirus / pathogenicity
  • Clinical Decision-Making
  • Comorbidity*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / mortality*
  • Coronavirus Infections / therapy
  • Coronavirus Infections / virology
  • Critical Illness / mortality*
  • Female
  • Hospital Mortality
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Models, Statistical*
  • Pandemics
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / mortality*
  • Pneumonia, Viral / therapy
  • Pneumonia, Viral / virology
  • Prognosis
  • Retrospective Studies
  • Risk Assessment / methods
  • Severity of Illness Index*

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2