Prediction of the need for intensive oxygen supplementation during the hospitalization among patients with COVID 19 admitted to an academic health system in Texas, USA: a retrospective cohort study and development of a multivariable regression model

Objective The severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) has caused a pandemic claiming more than 4 million lives worldwide. Overwhelming Coronavirus-Disease-2019 (COVID-19) respiratory failure placed tremendous demands on healthcare systems increasing the death toll. Cost-effective prognostic tools to characterize COVID-19 patients’ likely to progress to severe hypoxemic respiratory failure are still needed. Design We conducted a retrospective cohort study to develop a model utilizing demographic and clinical data collected in the first 12-hours admission to explore associations with severe hypoxemic respiratory failure in unvaccinated and hospitalized COVID-19 patients. Setting University based healthcare system including 6 hospitals located in the Galveston, Brazoria and Harris counties of Texas. Participants Adult patients diagnosed with COVID-19 and admitted to one of six hospitals between March 19th and June 31st, 2020. Primary outcome The primary outcome was defined as reaching a WHO ordinal scale between 6-9 at any time during admission, which corresponded to severe hypoxemic respiratory failure requiring high-flow oxygen supplementation or mechanical ventilation. Results We included 329 participants in the model cohort and 62 (18.8%) met the primary outcome. Our multivariable regression model found that lactate dehydrogenase (OR 2.36), qSOFA score (OR: 2.26), and neutrophil to lymphocyte ratio (OR:1.15) were significant predictors of severe disease. The final model showed an area under curve (AUC) of 0.84. The sensitivity analysis and point of influence analysis did not reveal inconsistencies. Conclusions Our study suggests that a combination of accessible demographic and clinical information collected on admission may predict the progression to severe COVID-19 among adult patients with mild and moderate disease. This model requires external validation prior to its use. STRENGTHS AND LIMITATIONS OF THIS STUDY ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No extramural funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol was approved by UTMB Institutional Review Board (#20-0126) and the Texas Department of Criminal Justice (TDCJ) Institutional Review Board (#819-RM20). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes SAS Code will be published at Dryad, an online repository. TDCJ prisoners will be excluded from this data. * (SARS-CoV-2) : Severe acute respiratory syndrome-Coronoavius-2 (COVID-19) : Coronaviurs-Disease-19 (WHO) : World Health Organization (CDC) : Center of Disease Control and Prevention (UTMB) : University of Texas Medical Branch (TDCJ) : Texas Department of Criminal Justice (GCS) : Glawgow coma scale (qSOFA) : Quick Sequential Organ Failure Assessment (NLR) : Neutrophil to lymphocyte ratio (LDH) : Lactate Dehydrogenase (CRP) : C-reactive protein (BMI) : Body mass index (IQR) : Interquartile range (SD) : Standard deviation (AIC) : Stepwise Akaike Information Criteria (GOF) : Goodness of fit (ROC) : Receiver operating characteristics curve (AUC) : Area under the curve