Development and validation of an early warning score (EWAS) for predicting clinical deterioration in patients with coronavirus disease 2019

Yabing Guo; Yingxia Liu; Jiatao Lu; Rong Fan; Fuchun Zhang; Xueru Yin; Zhihong Liu; Qinglang Zeng; Jing Yuan; Shufang Hu; Qiongya Wang; Baolin Liao; Mingxing Huang; Sichun Yin; Xilin Zhang; Rui Xin; Zhanzhou Lin; Changzheng Hu; Boliang Zhao; Ridong He; Minfeng Liang; Zheng Zhang; Li Liu; Jian Sun; Lu Tang; Lisi Deng; Jinyu Xia; Xiaoping Tang; Lei Liu; Jinlin Hou

The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.04. 17.20064691 doi: medRxiv preprint progression in most diseases. The most common chronic diseases in our cohort were hypertension, pre-existing cardiac conditions, chronic lung disease and diabetes, which had prevalence rates of 12.6%, 12.2%, 7.3% and 5.5% in the training cohort, respectively. These comorbidities are found to be important risk factors in previously reported seriously ill or non-survival COVID-19 patients. In addition, patients with these illnesses may receive angiotensin-converting enzyme (ACE) inhibitor treatments. These regimens increase the expression of ACE2, which is the receptor of SARS-CoV-2 and may contribute to disease progression. 15, 16 One of the reported early general manifestations in the course of SARS-CoV-2 infection is lymphocytopenia in the presence of a normal WBC count and more prominent abnormalities in lymphocyte counts are identified in patients with more severe pneumonia. In the present study, a correlation between a higher neutrophil count and early deterioration was also observed. Hence, we included the NLR in the multivariable regression analysis. Additionally, NLR is used as a predictor of community acquired pneumonia (CAP), specifically in elderly patients. [17] [18] [19] CRP is a common indicator of the inflammatory response. Its prediction value of disease progression has been reported in MERS, influenza-infected and CAP patients. [20] [21] [22] In our study, a CRP level higher than 25 mg/L at admission may indicate an underlying secondary infection or an intense inflammatory response that may lead to disease progression in the short term. Another factor, D-dimer, is associated with coagulation activation, which has been previously been reported to be a common finding in COVID-19 patients who had severe illness or died. Additionally, elevated D-dimer is one of the risk factors for the development of acute respiratory distress syndrome (ARDS), progression from ARDS to death or early in-hospital death in COVID-19 patients. 23, 24 The possible mechanisms include ischemia and thrombosis caused by systemic proinflammatory cytokine responses, which are reported to be mediators of atherosclerosis All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity.