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Issue 12, 2020
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Clinical decision support tool and rapid point-of-care platform for determining disease severity in patients with COVID-19

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Abstract

SARS-CoV-2 is the virus that causes coronavirus disease (COVID-19) which has reached pandemic levels resulting in significant morbidity and mortality affecting every inhabited continent. The large number of patients requiring intensive care threatens to overwhelm healthcare systems globally. Likewise, there is a compelling need for a COVID-19 disease severity test to prioritize care and resources for patients at elevated risk of mortality. Here, an integrated point-of-care COVID-19 Severity Score and clinical decision support system is presented using biomarker measurements of C-reactive protein (CRP), N-terminus pro B type natriuretic peptide (NT-proBNP), myoglobin (MYO), D-dimer, procalcitonin (PCT), creatine kinase-myocardial band (CK-MB), and cardiac troponin I (cTnI). The COVID-19 Severity Score combines multiplex biomarker measurements and risk factors in a statistical learning algorithm to predict mortality. The COVID-19 Severity Score was trained and evaluated using data from 160 hospitalized COVID-19 patients from Wuhan, China. Our analysis finds that COVID-19 Severity Scores were significantly higher for the group that died versus the group that was discharged with median (interquartile range) scores of 59 (40–83) and 9 (6–17), respectively, and area under the curve of 0.94 (95% CI 0.89–0.99). Although this analysis represents patients with cardiac comorbidities (hypertension), the inclusion of biomarkers from other pathophysiologies implicated in COVID-19 (e.g., D-dimer for thrombotic events, CRP for infection or inflammation, and PCT for bacterial co-infection and sepsis) may improve future predictions for a more general population. These promising initial models pave the way for a point-of-care COVID-19 Severity Score system to impact patient care after further validation with externally collected clinical data. Clinical decision support tools for COVID-19 have strong potential to empower healthcare providers to save lives by prioritizing critical care in patients at high risk for adverse outcomes.

Graphical abstract: Clinical decision support tool and rapid point-of-care platform for determining disease severity in patients with COVID-19

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Supplementary files

Article information


Submitted
11 Apr 2020
Accepted
30 Apr 2020
First published
03 Jun 2020

This article is Open Access

Lab Chip, 2020,20, 2075-2085
Article type
Paper

Clinical decision support tool and rapid point-of-care platform for determining disease severity in patients with COVID-19

M. P. McRae, G. W. Simmons, N. J. Christodoulides, Z. Lu, S. K. Kang, D. Fenyo, T. Alcorn, I. P. Dapkins, I. Sharif, D. Vurmaz, S. S. Modak, K. Srinivasan, S. Warhadpande, R. Shrivastav and J. T. McDevitt, Lab Chip, 2020, 20, 2075
DOI: 10.1039/D0LC00373E

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    [Original citation] - Published by The Royal Society of Chemistry (RSC) on behalf of the Centre National de la Recherche Scientifique (CNRS) and the RSC.
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    [Original citation] - Published by The Royal Society of Chemistry (RSC) on behalf of the European Society for Photobiology, the European Photochemistry Association, and RSC.
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    [Original citation] - Published by The Royal Society of Chemistry.

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