Review: Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19

Review: Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19

In this study, 10 independent clinical predictors were identified and used to develop a risk score (COVID-GRAM) that predicts development of critical illness from COVID-19. 

  • Study took place in China: A retrospective cohort of patients with COVID-19 was established as a development cohort of 1590 patients. Data from 4 additional Chinese cohorts was used to create a validation cohort of 710 patients
  • Outcome targeted for prediction was critical illness,  defined as the composite measure of admission to the intensive care unit, invasive ventilation, or death.
  • From 72 potential predictors, 10 variables were independent predictive factors and were included in the risk score:
    • Chest radiographic abnormality (OR, 3.39; 95% CI, 2.14-5.38)
    • Age (OR, 1.03; 95% CI, 1.01-1.05)
    • Hemoptysis (OR, 4.53; 95% CI, 1.36-15.15)
    • Dyspnea (OR, 1.88; 95% CI, 1.18-3.01)
    • Unconsciousness (OR, 4.71; 95% CI, 1.39-15.98)
    • Number of comorbidities (OR, 1.60; 95% CI, 1.27-2.00)
    • Cancer history (OR, 4.07; 95% CI, 1.23-13.43)
    • Neutrophil-to-lymphocyte ratio (OR, 1.06; 95% CI, 1.02-1.10)
    • Lactate dehydrogenase (OR, 1.002; 95% CI, 1.001-1.004)
    • Direct bilirubin (OR, 1.15; 95% CI, 1.06-1.24)
  • The accuracy of COVID risk score was determined by an area-under-the-curve (AUC) value, which was 0.88 (95% CI, 0.84-0.93) in the validation cohort
  • The score has been translated into an online risk calculator that is freely available to the public (
|2020-05-13T08:50:43-04:00May 12th, 2020|COVID-19 Literature|0 Comments

About the Author: Megan McHenry

Megan McHenry
Megan S. McHenry, MD, MS, FAAP is a pediatrician and an Assistant Professor of Pediatrics in the Ryan White Center for Pediatric Infectious Disease and Global Health at Indiana University School of Medicine. Dr. McHenry's research focuses on early childhood development in children living in resource-limited settings. This work is frequently aligned with community-engaged research and dissemination and implementation science frameworks. She primarily conducts research in collaboration with the Academic Model for Providing Access to Healthcare (AMPATH) Research Network in Kenya. Dr. McHenry currently has a career development award through the National Institutes of Health to develop a neurodevelopmental screening program for children born to HIV-infected mothers in Kenya. Dr. McHenry is also the Director of Pediatric Global Health Education and a co-Director of the Morris Green Physician-Scientist Development Program at Indiana University School of Medicine. In additional to global health lectures, she also educates residents and students on early childhood development, basic biostatistical techniques, research methodologies, and research ethics. She mentors multiple pediatric fellows, residents, and medical students interested in early childhood development within global contexts.

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