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Assessment of the Performance Consistency of an Adverse Outcome Prediction Tool for Patients Hospitalized With COVID-19

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

The challenge of managing limited resources during the COVID-19 pandemic has sparked efforts to stratify risk among hospitalized patients.1 Few risk models have been validated or investigated for potential bias2 even though inpatient populations, treatments, and outcomes for COVID-19 have changed over time. We previously3 reported and validated a risk prediction tool based on COVID-19 hospitalizations during the initial wave of the pandemic. In this study, we report the performance of that same model on subsequent data from 6 hospitals collected during the second wave of patients with COVID-19.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: May 23, 2021.

Published: July 27, 2021. doi:10.1001/jamanetworkopen.2021.18413

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Castro VM et al. JAMA Network Open.

Corresponding Author: Roy H. Perlis, MD, MSc, Center for Quantitative Health, Division of Clinical Research, Massachusetts General Hospital, 185 Cambridge St, 6th Floor, Boston, MA 02114 (rperlis@mgh.harvard.edu).

Author Contributions: Dr Perlis had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Castro, Perlis.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: All authors.

Administrative, technical, or material support: Castro, McCoy.

Supervision: McCoy.

Conflict of Interest Disclosures: Dr McCoy reported receiving grants from the Brain and Behavior Research Foundation, the National Institute of Mental Health, the National Institute of Nursing Research, the National Human Genome Research Institute, and Telefonica Alfa outside the submitted work. Dr Perlis reported holding equity in Psy Therapeutics and Outermost Therapeutics and receiving consulting fees from Belle Artificial Intelligence, Burrage Capital, Genomind, and RID Ventures outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by grant R01MH116270 from the National Institute of Mental Health to Dr Perlis.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: Dr Perlis is associate editor of JAMA Network Open, but he was not involved in any of the decisions regarding review of the manuscript or its acceptance.

References
1.
Knight  SR , Ho  A , Pius  R ,  et al; ISARIC4C investigators.  Risk stratification of patients admitted to hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: development and validation of the 4C Mortality Score.   BMJ. 2020;370:m3339. doi:10.1136/bmj.m3339PubMedGoogle Scholar
2.
Griffith  GJ , Morris  TT , Tudball  MJ ,  et al.  Collider bias undermines our understanding of COVID-19 disease risk and severity.   Nat Commun. 2020;11(1):5749. doi:10.1038/s41467-020-19478-2PubMedGoogle ScholarCrossref
3.
Castro  VM , McCoy  TH , Perlis  RH .  Laboratory findings associated with severe illness and mortality among hospitalized individuals with coronavirus disease 2019 in eastern Massachusetts.   JAMA Netw Open. 2020;3(10):e2023934. doi:10.1001/jamanetworkopen.2020.23934PubMedGoogle Scholar
4.
Nalichowski  R , Keogh  D , Chueh  HC , Murphy  SN .  Calculating the benefits of a research patient data repository.   AMIA Annu Symp Proc. 2006;2006:1044.PubMedGoogle Scholar
5.
Charlson  M , Szatrowski  TP , Peterson  J , Gold  J .  Validation of a combined comorbidity index.   J Clin Epidemiol. 1994;47(11):1245-1251. doi:10.1016/0895-4356(94)90129-5PubMedGoogle ScholarCrossref
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