tetano
Editor, Senior Moderator
PLoS One
. 2022 Apr 11;17(4):e0266750.
doi: 10.1371/journal.pone.0266750. eCollection 2022.
Cardiovascular vulnerability predicts hospitalisation in primary care clinically suspected and confirmed COVID-19 patients: A model development and validation study
Florien S van Royen[SUP] 1 [/SUP], Linda P T Joosten[SUP] 1 [/SUP], Maarten van Smeden[SUP] 2 [/SUP], Pauline Slottje[SUP] 3 [/SUP], Frans H Rutten[SUP] 1 [/SUP], Geert-Jan Geersing[SUP] 1 [/SUP], Sander van Doorn[SUP] 1 [/SUP]
Affiliations
Abstract
Objectives: Cardiovascular conditions were shown to be predictive of clinical deterioration in hospitalised patients with coronavirus disease 2019 (COVID-19). Whether this also holds for outpatients managed in primary care is yet unknown. The aim of this study was to determine the incremental value of cardiovascular vulnerability in predicting the risk of hospital referral in primary care COVID-19 outpatients.
Design: Analysis of anonymised routine care data extracted from electronic medical records from three large Dutch primary care registries.
Setting: Primary care.
Participants: Consecutive adult patients seen in primary care for COVID-19 symptoms in the 'first wave' of COVID-19 infections (March 1 2020 to June 1 2020) and in the 'second wave' (June 1 2020 to April 15 2021) in the Netherlands.
Outcome measures: A multivariable logistic regression model was fitted to predict hospital referral within 90 days after first COVID-19 consultation in primary care. Data from the 'first wave' was used for derivation (n = 5,475 patients). Age, sex, the interaction between age and sex, and the number of cardiovascular conditions and/or diabetes (0, 1, or ≥2) were pre-specified as candidate predictors. This full model was (i) compared to a simple model including only age and sex and its interaction, and (ii) externally validated in COVID-19 patients during the 'second wave' (n = 16,693).
Results: The full model performed better than the simple model (likelihood ratio test p<0.001). Older male patients with multiple cardiovascular conditions and/or diabetes had the highest predicted risk of hospital referral, reaching risks above 15-20%, whereas on average this risk was 5.1%. The temporally validated c-statistic was 0.747 (95%CI 0.729-0.764) and the model showed good calibration upon validation.
Conclusions: For patients with COVID-19 symptoms managed in primary care, the risk of hospital referral was on average 5.1%. Older, male and cardiovascular vulnerable COVID-19 patients are more at risk for hospital referral.
. 2022 Apr 11;17(4):e0266750.
doi: 10.1371/journal.pone.0266750. eCollection 2022.
Cardiovascular vulnerability predicts hospitalisation in primary care clinically suspected and confirmed COVID-19 patients: A model development and validation study
Florien S van Royen[SUP] 1 [/SUP], Linda P T Joosten[SUP] 1 [/SUP], Maarten van Smeden[SUP] 2 [/SUP], Pauline Slottje[SUP] 3 [/SUP], Frans H Rutten[SUP] 1 [/SUP], Geert-Jan Geersing[SUP] 1 [/SUP], Sander van Doorn[SUP] 1 [/SUP]
Affiliations
- PMID: 35404964
- DOI: 10.1371/journal.pone.0266750
Abstract
Objectives: Cardiovascular conditions were shown to be predictive of clinical deterioration in hospitalised patients with coronavirus disease 2019 (COVID-19). Whether this also holds for outpatients managed in primary care is yet unknown. The aim of this study was to determine the incremental value of cardiovascular vulnerability in predicting the risk of hospital referral in primary care COVID-19 outpatients.
Design: Analysis of anonymised routine care data extracted from electronic medical records from three large Dutch primary care registries.
Setting: Primary care.
Participants: Consecutive adult patients seen in primary care for COVID-19 symptoms in the 'first wave' of COVID-19 infections (March 1 2020 to June 1 2020) and in the 'second wave' (June 1 2020 to April 15 2021) in the Netherlands.
Outcome measures: A multivariable logistic regression model was fitted to predict hospital referral within 90 days after first COVID-19 consultation in primary care. Data from the 'first wave' was used for derivation (n = 5,475 patients). Age, sex, the interaction between age and sex, and the number of cardiovascular conditions and/or diabetes (0, 1, or ≥2) were pre-specified as candidate predictors. This full model was (i) compared to a simple model including only age and sex and its interaction, and (ii) externally validated in COVID-19 patients during the 'second wave' (n = 16,693).
Results: The full model performed better than the simple model (likelihood ratio test p<0.001). Older male patients with multiple cardiovascular conditions and/or diabetes had the highest predicted risk of hospital referral, reaching risks above 15-20%, whereas on average this risk was 5.1%. The temporally validated c-statistic was 0.747 (95%CI 0.729-0.764) and the model showed good calibration upon validation.
Conclusions: For patients with COVID-19 symptoms managed in primary care, the risk of hospital referral was on average 5.1%. Older, male and cardiovascular vulnerable COVID-19 patients are more at risk for hospital referral.