Research Paper|Volume 13, Issue 3|pp 3176—3189

Development and validation of a prognostic nomogram for predicting in-hospital mortality of COVID-19: a multicenter retrospective cohort study of 4086 cases in China

Li Li^1,², Xiaoyu Fang^3,⁴, Lixia Cheng^5,⁶, Penghao Wang⁷, Shen Li⁷, Hao Yu⁸, Yao Zhang⁴, Nan Jiang¹, Tingting Zeng¹, Chao Hou¹, Jing Zhou¹, Shiru Li⁴, Yingzi Pan⁴, Yitong Li⁴, Lili Nie⁴, Yang Li⁹, Qidi Sun^2,⁵, Hong Jia³, Mengxia Li^6,¹⁰, Guoqiang Cao^1,², Xiangyu Ma⁴

¹Department of Respiratory Medicine, Daping Hospital, Army Medical University, Former Third Military Medical University, Chongqing, China
²Wuhan Huoshenshan Hospital, Wuhan, China
³College of Public Health, Southwest Medical University, Luzhou, Sichuan, China
⁴Department of Epidemiology, College of Preventive Medicine, Army Medical University, Former Third Military Medical University, Chongqing, China
⁵Daping Hospital, Army Medical University, Former Third Military Medical University, Chongqing, China
⁶Wuhan Taikang Tongji Hospital, Wuhan, China
⁷The Second Clinical College, Chongqing Medical University, Chongqing, China
⁸Department of Endocrinology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
⁹NCO School of Army Medical University, Former Third Military Medical University, Shijiazhuang, Hebei, China
¹⁰Department of Oncology, Daping Hospital, Army Medical University, Former Third Military Medical University, Chongqing, China

* Equal contribution

Received: October 23, 2020Accepted: December 23, 2020Published: February 9, 2021

https://doi.org/10.18632/aging.202605

Copyright: © 2021 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

To establish an effective nomogram for predicting in-hospital mortality of COVID-19, a retrospective cohort study was conducted in two hospitals in Wuhan, China, with a total of 4,086 hospitalized COVID-19 cases. All patients have reached therapeutic endpoint (death or discharge). First, a total of 3,022 COVID-19 cases in Wuhan Huoshenshan hospital were divided chronologically into two sets, one (1,780 cases, including 47 died) for nomogram modeling and the other (1,242 cases, including 22 died) for internal validation. We then enrolled 1,064 COVID-19 cases (29 died) in Wuhan Taikang-Tongji hospital for external validation. Independent factors included age (HR for per year increment: 1.05), severity at admission (HR for per rank increment: 2.91), dyspnea (HR: 2.18), cardiovascular disease (HR: 3.25), and levels of lactate dehydrogenase (HR: 4.53), total bilirubin (HR: 2.56), blood glucose (HR: 2.56), and urea (HR: 2.14), which were finally selected into the nomogram. The C-index for the internal resampling (0.97, 95% CI: 0.95-0.98), the internal validation (0.96, 95% CI: 0.94-0.98), and the external validation (0.92, 95% CI: 0.86-0.98) demonstrated the fair discrimination ability. The calibration plots showed optimal agreement between nomogram prediction and actual observation. We established and validated a novel prognostic nomogram that could predict in-hospital mortality of COVID-19 patients.