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Development and Validation of an Acute Respiratory Distress Syndrome Prediction Model in Coronavirus Disease-2019: Updated Lung Injury Prediction Score

Published:December 30, 2022DOI:
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      To develop and validate an updated lung injury prediction score (c-LIPS) tailored for predicting acute respiratory distress syndrome (ARDS) in coronavirus disease-2019.

      Patients and Methods

      This was a registry-based cohort study using the Viral Infection and Respiratory Illness Universal Study. Hospitalized adult patients between January 2020 and January 2022 were screened. Patients who qualified for ARDS within the first day of admission were excluded. Development cohort consisted of patients enrolled from participating Mayo Clinic sites. The validation analyses were carried out on remaining patients enrolled from more than 120 hospitals in 15 countries. The original LIPS was calculated and enhanced using reported COVID-19 specific laboratory risk factors, constituting c-LIPS. The main outcome was ARDS development and secondary outcomes included hospital mortality, invasive mechanical ventilation, progression in World Health Organization ordinal scale.


      The derivation cohort consisted of 3710 patients, of whom 28% developed ARDS. The c-LIPS discriminated COVID-19 patients who developed ARDS with an AUC of 0.79 compared to original LIPS (AUC 0.74, P<.001) with good calibration accuracy (Hosmer-Lemeshow P=.50). Despite different characteristics of the two cohorts, the c-LIPS’s performance was comparable in the validation cohort of 5426 patients (16% ARDS), with an AUC of 0.74; and its discriminatory performance was significantly higher than the LIPS (AUC 0.68, P<.001). The c-LIPS’s performance in predicting the requirement for invasive mechanical ventilation in derivation and validation cohorts had an AUC of 0.74 and 0.72, respectively.


      In this large patient sample c-LIPS was successfully tailored to predict ARDS in COVID-19 patients.


      ARDS (acute respiratory distress syndrome), ARF (acute respiratory failure), AST (aspartate aminotransferase), AUC (area under the curve), c-LIPS (lung injury prediction score for COVID-19 patients), COVID-19 (Coronavirus disease 2019), CRP (C-reactive protein), HFNC (high flow nasal cannula), IQR (interquartile range), LIPS (lung injury prediction score), PaO2/FiO2 (partial pressure of arterial oxygen to fractional inspired oxygen ratio), ROC (receiver operating characteristic), SCCM (Society of Critical Care Medicine), SpO2 (oxygen saturation), VIRUS (Viral Infection and Respiratory Illness Universal Study), WHO (World Health Organization)