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

which there is no pre-existing immunity in humans. The continued increase in the number of cases with COVID-19 and the number of affected countries over time are of great concern. On February 28, 2020, the World Health Organization (WHO) raised the international risk assessment for the COVID-19 outbreak from "high" to "very high" nearly a month after the novel coronavirus was declared a public health emergency of international concern, which is the WHO's highest level alarm. 1 As of April 13, 2020 , the global number of reported cases of COVID-19 has reached 1 773 084, with 83 597 cases in China and 1 689 487 cases outside of China. 2 Hubei Province was the center of the epidemic area in the early stage of the pandemic. As of April 13, 2020, 6 7803 confirmed cases with COVID-19 were reported in Hubei Province, 2 which accounted for over 80% of the cases in China, and the case fatality rate in Hubei Province was five times greater than in areas outside of Hubei Province. 3 Moreover, approximately 26% of cases developed severe disease in Hubei Province which accounted for 98% of the severe cases in China. Guangdong Province had the second largest number of confirmed cases with COVID-19 in China outside of Hubei, with 1 564 reported cases as of April 13, 2020. 2 Based on the clinical characteristics reported by patients with COVID-19, around 80% of the patients were diagnosed with mild or moderate COVID-19 and a part of those will develop severe disease rapidly. 4, 5 The median time from onset to clinical recovery for mild cases is approximately two weeks, and it is three to six weeks for patients with severe or critical COVID-19. 4 Previous studies found that older patients with underlying chronic illnesses, such as hypertension and diabetes, are more likely to develop severe pneumonia. [5] [6] [7] [8] [9] [10] Moreover, it was reported that patients with severe pneumonia in All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity.