Estimating risk of mechanical ventilation and in-hospital mortality among adult COVID-19 patients admitted to Mass General Brigham: The VICE and DICE scores

Christopher J Nicholson; Luke Wooster; Haakon H Sigurslid; Rebecca H Li; Wanlin Jiang; Wenjie Tian; Christian L Lino Cardenas; Rajeev Malhotra

doi:10.1016/j.eclinm.2021.100765

Estimating risk of mechanical ventilation and in-hospital mortality among adult COVID-19 patients admitted to Mass General Brigham: The VICE and DICE scores

EClinicalMedicine. 2021 Mar:33:100765. doi: 10.1016/j.eclinm.2021.100765. Epub 2021 Feb 25.

Authors

Christopher J Nicholson¹, Luke Wooster², Haakon H Sigurslid¹, Rebecca H Li¹, Wanlin Jiang¹, Wenjie Tian^{1

3}, Christian L Lino Cardenas¹, Rajeev Malhotra¹

Affiliations

¹ Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States.
² Case Western Reserve University School of Medicine, Cleveland, Ohio, United States.
³ Department of Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China.

Abstract

Background: Risk stratification of COVID-19 patients upon hospital admission is key for their successful treatment and efficient utilization of hospital resources. We sought to evaluate the risk factors on admission (including comorbidities, vital signs, and initial laboratory assessment) associated with ventilation need and in-hospital mortality in COVID-19.

Methods: We established a retrospective cohort of COVID-19 patients from Mass General Brigham hospitals. Demographic, clinical, and admission laboratory data were obtained from electronic medical records of patients admitted to the hospital with laboratory-confirmed COVID-19 before May 19, 2020. Multivariable logistic regression analyses were used to construct and validate the Ventilation in COVID Estimator (VICE) and Death in COVID Estimator (DICE) risk scores.

Findings: The entire cohort included 1042 patients (median age, 64 years; 56.8% male). The derivation and validation cohorts for the risk scores included 578 and 464 patients, respectively. We found four factors to be independently predictive for mechanical ventilation requirement (diabetes mellitus, SpO₂:FiO₂ ratio, C-reactive protein, and lactate dehydrogenase), and 10 factors to be predictors of in-hospital mortality (age, male sex, coronary artery disease, diabetes mellitus, chronic statin use, SpO₂:FiO₂ ratio, body mass index, neutrophil to lymphocyte ratio, platelet count, and procalcitonin). Using these factors, we constructed the VICE and DICE risk scores, which performed with C-statistics of 0.84 and 0.91, respectively. Importantly, the chronic use of a statin was associated with protection against death due to COVID-19. The VICE and DICE score calculators have been placed on an interactive website freely available to healthcare providers and researchers (https://covid-calculator.com/).

Interpretation: The risk scores developed in this study may help clinicians more appropriately determine which COVID-19 patients will need to be managed with greater intensity.

Funding: COVID-19 Fast Grant (fastgrants.org).

Grants and funding

T32 HL007208/HL/NHLBI NIH HHS/United States