key: cord-0827024-h50qlf5r
authors: Zhang, Jianrong; Fok, Louis; Zhao, Yueming; Xu, Zhiheng
title: Generalizability of COVID-19 Mortality Risk Score Model
date: 2020-08-19
journal: Am J Prev Med
DOI: 10.1016/j.amepre.2020.07.021
sha: 2a346844a0e467e76da7100ab971ba3daa7de209
doc_id: 827024
cord_uid: h50qlf5r

nan

It is with deep appreciation that we read the research by Yu et al. 1 investigating risk factors for mortality among 1,663 patients hospitalized with the novel coronavirus disease 2019 in a Wuhan, China hospital that utilized clinical characteristics in the development of a statistical model that predicts death risk. 1 Given that the ongoing pandemic has placed great pressure on healthcare systems worldwide, we consider prediction models to be of high utility in assessing which patients with COVID-19 have higher mortality risk so as to optimize healthcare resources.

To better apply this prediction model to clinical care around the world, future validation studies are warranted. Considering the variability in health service capacities and policies across different settings, we feel that such a model deserves to be further validated-or even refinedin order to generalize it to patients in other countries and regions (e.g., non-epicenters in China, the U.S., Australia). As has been noted, 2 all confirmed and suspected COVID-19 patients in Wuhan are hospitalized regardless of illness severity; such practice may not be necessary/feasible in other countries/regions, where COVID-19 patients with asymptomatic or mild illness could be routinely discharged and isolated at home. In light of the different conditions between inpatient and outpatient care, we call for future prediction studies for all confirmed cases, hospitalized and non-hospitalized COVID-19 patients, to understand how to design and apply this model effectively. Furthermore, social determinants of health, in addition to clinical risk factors, vary both among and within populations (e.g., Chinese versus American).

For instance, differences in illness severity have been observed between racial groups in the U.S. 3 In addition to further validation and development of the prediction model, we hope for 2 more studies on the characteristics and risk/prognostic factors for important outcomes (e.g., hospitalization, 4 critical illness 4,5 ) related to COVID-19 in different national or subnational regions, as well as among general COVID-19 cohorts or specific COVID-19 cohorts like pediatric 6 or obstetric patients. 7 Successful efforts to address these matters will enable a better understanding of the coronavirus, helping to develop accurate clinical predictions that can maximize efficiency in healthcare delivery.

Clinical characteristics, associated factors, and predicting COVID-19 mortality risk: a retrospective study in Wuhan, China

Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan

Hospitalization and mortality among Black patients and White patients with Covid-19

Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study

Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19

Clinical characteristics and outcomes of hospitalized and critically ill children and adolescents with coronavirus disease 2019 (COVID-19) at a tertiary care medical center in New York City

Symptoms and critical illness among obstetric patients with coronavirus disease 2019 (COVID-19) infection

No financial disclosures were reported by the authors of this paper. 5