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Mortality in patients treated for COVID-19 in the emergency department of a tertiary care hospital during the first phase of the pandemic: Derivation of a risk model for emergency departments

Garc√≠a-Mart√≠nez A, L√≥pez-Barbeito B, Coll-Vinent B, Placer A, Font C, Vargas CR, S√°nchez C, Pi√Īango D, G√≥mez-Angelats E, Curtelin D, Salgado E, Aya F, Mart√≠nez-Nadal G, Alonso JR, Garc√≠a-Gonzalbes J, Fresco L, Galicia M, Perea M, Carb√≥ M, Iniesta N, Escoda O, Perell√≥ R, Cuerpo S, Flores V, Alemany X, Mir√≥ O, Ortega Romero M

√Ārea de Urgencias, Hospital Clinic, Barcelona, Espa√Īa. Universitat de Barcelona, Spain.

Objective. To develop a risk model to predict 30-day mortality after emergency department treatment for COVID-19.
Methods. Observational retrospective cohort study including 2511 patients with COVID-19 who came to our emergency department between March 1 and April 30, 2020. We analyzed variables with Kaplan Meier survival and Cox regression analyses.
Results. All-cause mortality was 8% at 30 days. Independent variables associated with higher risk of mortality were age over 50 years, a Barthel index score less than 90, altered mental status, the ratio of arterial oxygen saturation to the fraction of inspired oxygen (SaO2/FIO2), abnormal lung sounds, platelet concentration less than 100 000/mm3, a C-reactive protein concentration of 5 mg/dL or higher, and a glomerular filtration rate less than 45 mL/min. Each independent predictor was assigned 1 point in the score except age, which was assigned 2 points. Risk was distributed in 3 levels: low risk (score of 4 points or less), intermediate risk (5 to 6 points), and high risk (7 points or above). Thirty-day risk of mortality was 1.7% for patients who scored in the low-risk category, 28.2% for patients with an intermediate risk score, and 67.3% for those with a high risk score.
Conclusion. This mortality risk stratification tool for patients with COVID-19 could be useful for managing the course of disease and assigning health care resources in the emergency department.

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