Value of dynamic clinical and biomarker data for mortality risk prediction in COVID-19: a multicentre retrospective cohort study

BMJ Open. 2020 Sep 23;10(9):e041983. doi: 10.1136/bmjopen-2020-041983.


Objectives: Being able to predict which patients with COVID-19 are going to deteriorate is important to help identify patients for clinical and research practice. Clinical prediction models play a critical role in this process, but current models are of limited value because they are typically restricted to baseline predictors and do not always use contemporary statistical methods. We sought to explore the benefits of incorporating dynamic changes in routinely measured biomarkers, non-linear effects and applying 'state-of-the-art' statistical methods in the development of a prognostic model to predict death in hospitalised patients with COVID-19.

Design: The data were analysed from admissions with COVID-19 to three hospital sites. Exploratory data analysis included a graphical approach to partial correlations. Dynamic biomarkers were considered up to 5 days following admission rather than depending solely on baseline or single time-point data. Marked departures from linear effects of covariates were identified by employing smoothing splines within a generalised additive modelling framework.

Setting: 3 secondary and tertiary level centres in Greater Manchester, the UK.

Participants: 392 hospitalised patients with a diagnosis of COVID-19.

Results: 392 patients with a COVID-19 diagnosis were identified. Area under the receiver operating characteristic curve increased from 0.73 using admission data alone to 0.75 when also considering results of baseline blood samples and to 0.83 when considering dynamic values of routinely collected markers. There was clear non-linearity in the association of age with patient outcome.

Conclusions: This study shows that clinical prediction models to predict death in hospitalised patients with COVID-19 can be improved by taking into account both non-linear effects in covariates such as age and dynamic changes in values of biomarkers.

Keywords: intensive & critical care; respiratory infections; statistics & research methods.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Betacoronavirus
  • Bilirubin / blood*
  • Biomarkers / blood
  • C-Reactive Protein / metabolism*
  • COVID-19
  • Cohort Studies
  • Coronavirus Infections / blood
  • Coronavirus Infections / mortality*
  • Creatinine / blood*
  • Female
  • Hospitalization
  • Humans
  • Leukocyte Count
  • Lymphocyte Count*
  • Male
  • Middle Aged
  • Neutrophils*
  • Pandemics
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / mortality*
  • Prognosis
  • ROC Curve
  • Retrospective Studies
  • Risk Assessment
  • SARS-CoV-2
  • United Kingdom
  • Urea / blood*


  • Biomarkers
  • Urea
  • C-Reactive Protein
  • Creatinine
  • Bilirubin