Chinese Researchers Develop Mortality Index to Triage Coronavirus Patients


Since hospitals in parts of Wuhan China have been overwhelmed by cases of the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) disease (COVID-19), increasing the speed and efficiency of patient care has been critically important for saving the lives of as many infected individuals as possible.

Researchers from Wuhan Hankou Hospital and other chinese institutions recently developed a mortality risk index that could permit the triaging of coronavirus-infected individuals. By evaluating the clinical characteristics and outcomes data of suspected or confirmed coronavirus patients at a Wuhan hospital, the researchers hoped to create a risk index that could permit the more efficient management of infected patients.

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The scientists retrospectively evaluated laboratory, radiological, demographic, and clinical data from 577 patients that presented to Wuhan Hankou hospital between January 21st and February 5th 2020. The patient cohort had a median age of 55 years and was 44.0% male. 22.8% of the patients presented to the hospital with severe pneumonia and 37.7% tested positive for SARS-CoV-2. The 12-day cumulative mortality rate was 8.7% with 39 deaths among the patients in the cohort.

Using data from the patient cohort, the researchers developed a mortality risk index (‘ACP index’) based on patient age and c-reative protein (CRP) levels. The production of C-reactive protein by the liver is elevated during inflammatory periods such as viral infection and was interpreted as a marker for the severity of infection by the coronavirus. The patients were stratified into three groups using the ACP index: (1) age ≥ 60 years and CRP ≥ 34 mg/L; (2) age ≥ 60 years and CRP < 34 mg/L or age < 60 years and CRP ≥ 34 mg/L; (3) age < 60 years and CRP < 34 mg/L. The 12-day cumulative mortality rate of patients in the first group (33.2%) was found to be significantly higher than that of patients in the second (5.6%) and third (0.0%) groups.

The researchers concluded that the ACP index can predict short-term mortality of COVID-19 and suggested that their tool could be useful for improving medical care in regions impacted by the virus.

Lu J, Hu S, Fan R, et al. (2020) ACP risk grade: a simple mortality index for patients with confirmed or suspected severe acute respiratory syndrome coronavirus 2 disease (COVID-19) during the early stage of outbreak in Wuhan, China. medRxiv. doi: https://doi.org/10.1101/2020.02.20.20025510