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Original Article|Articles in Press

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

Published:December 30, 2022DOI:https://doi.org/10.1016/j.mayocp.2022.11.021
Development and Validation of an Acute Respiratory Distress Syndrome Prediction Model in Coronavirus Disease-2019: Updated Lung Injury Prediction Score
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      ABSTRACT

      Objective

      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.

      Results

      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.

      Conclusion

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

      ABBREVIATIONS:

      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)

      Article info

      Publication history

      Accepted: November 22, 2022
      Received in revised form: October 5, 2022
      Received: June 13, 2022

      Publication stage

      In Press Accepted Manuscript

      Footnotes

      Financial support and conflict of interest disclosure:

      This publication was supported by NIH/NCRR/NCATS CTSA Grant Number UL1 TR002377. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The VIRUS registry is funded in part by the Gordon and Betty Moore Foundation, and Janssen Research & Development, LLC. They had no influence on analysis, interpretation and reporting of pooled data. This study was supported by the Mayo Clinic Critical Care Independent Multidisciplinary Program (IMP) Research Subcommittee. They had no influence on the analysis, interpretation, and reporting of pooled data.

      R.K. receives funding from the National Institutes of Health/National Heart, Lung and Blood Institute: R01HL 130881, UG3/UH3HL 141722; Gordon and Betty Moore Foundation, and Janssen Research & Development, LLC; and royalties from Ambient Clinical Analytics. Inc. They had no influence on the acquisition, analysis, interpretation, and reporting of pooled data for this manuscript.

      AJW receives funding from the National Institutes of Health/National Heart, Lung and Blood Institute grants R01HL151607, R01HL139751, R01HL136660, Agency of Healthcare Research and Quality, R01HS026485, Boston Biomedical Innovation Center/NIH/NHLBI 5U54HL119145-07 and royalties from UpToDate.

      HY receives funding from the National Heart, Lung, and Blood Institute: K23HL151671.

      OG receives funding from the Agency of Healthcare Research and Quality R18HS 26609-2, National Institutes of Health/National Heart, Lung and Blood Institute: R01HL 130881, UG3/UH3HL 141722; Department of Defense DOD W81XWH; American Heart Association Rapid Response Grant – COVID-19; and royalties from Ambient Clinical Analytics. Inc.

      Clinical Trial Registration: Clinical Trials Database registration number for the VIRUS registry is NCT04323787.

      Identification

      DOI: https://doi.org/10.1016/j.mayocp.2022.11.021

      Copyright

      © 2023 Published by Elsevier Inc on behalf of Mayo Foundation for Medical Education and Research

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