CAPRL Scoring System for Prediction of 30-day Mortality in 949 Patients with Coronavirus Disease 2019 in Wuhan, China: A Retrospective, Observational Study

Chen, Hui-Long; Yan, Wei-Ming; Chen, Guang; Zhang, Xiao-Yun; Zeng, Zhi-Lin; Wang, Xiao-Jing; Qi, Wei-Peng; Wang, Min; Li, Wei-Na; Ma, Ke; Xu, Dong; Ni, Ming; Huang, Jia-Quan; Zhu, Lin; Zhang, Shen; Chen, Liang; Wang, Hong-Wu; Ding, Chen; Zhang, Xiao-Ping; Chen, Jia; Yu, Hai-Jing; Ding, Hong-Fang; Wu, Liang; Xing, Ming-You; Song, Jian-Xin; Chen, Tao; Luo, Xiao-Ping; Guo, Wei; Han, Mei-Fang; Wu, Di; Ning, Qin

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a serious and even lethal respiratory illness. The mortality of critically ill patients with COVID-19, especially short term mortality, is considerable. It is crucial and urgent to develop risk models that can predict the mortality risks of patients with COVID-19 at an early stage, which is helpful to guide clinicians in making appropriate decisions and optimizing the allocation of hospital resoureces. METHODS: In this retrospective observational study, we enrolled 949 adult patients with laboratory-confirmed COVID-19 admitted to Tongji Hospital in Wuhan between January 28 and February 12, 2020. Demographic, clinical and laboratory data were collected and analyzed. A multivariable Cox proportional hazard regression analysis was performed to calculate hazard ratios and 95% confidence interval for assessing the risk factors for 30-day mortality. RESULTS: The 30-day mortality was 11.8% (112 of 949 patients). Forty-nine point nine percent (474) patients had one or more comorbidities, with hypertension being the most common (359 [37.8%] patients), followed by diabetes (169 [17.8%] patients) and coronary heart disease (89 [9.4%] patients). Age above 50 years, respiratory rate above 30 beats per minute, white blood cell count of more than10 × 10(9)/L, neutrophil count of more than 7 × 10(9)/L, lymphocyte count of less than 0.8 × 10(9)/L, platelet count of less than 100 × 10(9)/L, lactate dehydrogenase of more than 400 U/L and high-sensitivity C-reactive protein of more than 50 mg/L were independent risk factors associated with 30-day mortality in patients with COVID-19. A predictive CAPRL score was proposed integrating independent risk factors. The 30-day mortality were 0% (0 of 156), 1.8% (8 of 434), 12.9% (26 of 201), 43.0% (55 of 128), and 76.7% (23 of 30) for patients with 0, 1, 2, 3, ≥4 points, respectively. CONCLUSIONS: We designed an easy-to-use clinically predictive tool for assessing 30-day mortality risk of COVID-19. It can accurately stratify hospitalized patients with COVID-19 into relevant risk categories and could provide guidance to make further clinical decisions.