Researchers have developed and validated a risk prediction m | Figure 1

Cleveland Clinic

Researchers have developed and validated a risk prediction model that can help physicians predict which patients who have recently tested positive for SARS-CoV-2 are at greatest risk for hospitalization for COVID-19.

The new model is the second COVID-19-related nomogram developed by the research team. Their earlier prediction model forecasts an individual patient’s likelihood of testing positive for the virus.

The model was developed and validated using retrospective data from more than 4,500 patients who tested positive for COVID-19 at Cleveland Clinic locations in Northeast Ohio and Florida during a three-month period. Data scientists used statistical algorithms to transform data from registry patients’ electronic medical records into the risk prediction model.

Comparing characteristics between patients who were and were not hospitalized due to COVID-19 revealed several previously undefined risk factors for hospitalization, including:

The team’s findings also revealed that patients presenting with a symptom complex including fever, shortness of breath, vomiting and fatigue were more likely to be hospitalized than those who did not experience this quadrumvirate of symptoms.

The study also confirmed other associations previously well established in the literature, including higher risk of hospitalization among older people, men, patients with comorbidities such as diabetes and hypertension, and individuals from lower socioeconomic backgrounds (as determined by ZIP code).

More on the free risk prediction model and how to access it:

Recent Findings on COVID-19 and Multiple Sclerosis

June 30, 2020

Last week the US Centers for Disease Control and Prevention updated its list of underlying conditions that increase a patients' risks of developing severe covid-19 illness. Unfortunately, the recommendations are not supported by large amounts of high-quality data for many common underlying illnesses. A paper in JAMA Neurology released late last week, adds some more information as pertaining to multiple sclerosis, the chronic degenerative disease of neurons in the brain and spinal cord. Given the concern over medicines known as disease-modifying therapies (DMTs) possibly increasing the risk of severe infection, French researchers retrospectively assessed an important registry of patients used by MS expert centers in France. The main outcome studied was the severity of covid-19 disease as determined by a 7-point ordinal severity score that has also been used in other covid-19 studies. A total of 347 patients were included and analyzed for this report. Women made up 72 percent of the patients with an average age 44.6. Among all patients, 21 percent had a severity score of three or greater, indicating that they required hospitalization but did not immediately require supplemental oxygen. Death occurred in 3.5 percent of patients. Among those patients receiving DMTs (82 percent), scores of 3 or higher were less frequent (15.5 percent) compared to MS patients not taking those medications (46 percent). Other risk factors for severe courses of illness were also noted, many of which have been observed in other covid-19 studies. Older age almost doubled the risk and obesity tripled it. The important insight of this study is the finding that there was no association between taking DMTs for MS and the risk of developing severe covid-19. These results should help guide ongoing treatment for MS patients who may have been worried about whether taking DMTs places them at higher risks of developing severe covid-19; it appears that these medications are not associated with any added risk and that MS patients should not routinely be instructed to cease taking them. However, because this was a retrospective study and therefore these conclusions are not irrefutable.

COVID-19 and Hypertension Medications

April 6, 2020

In a paper published in the preprint journal medRxiv, researchers in Wuhan, China analyzed medical records of patients hospitalized with confirmed SARS-CoV-2 infection. They separated patients with both covid-19 and high blood pressure (hypertension) into two groups: patients who had been prescribed the antihypertensives "ACE inhibitors" and "ARBs," and patients who had not been prescribed either of these medications. The question: do ACE inhibitors or ARBs have any effect, good or bad, on covid-19 infection? As previously covered in Brief19, experts have debated the use of these medications. In this new study, researchers found that patients taking ACE inhibitors and ARBs were much less likely to develop "very severe" covid-19, and also had lower death rates. Does this mean that patients who have their elevated blood pressure under control have a better chance at good outcomes? It’s possible. High blood pressure appears to be a risk factor for poorer outcomes. Alternatively, might these medications even actively interrupt the virus’ attempt to enter cells? Too soon to say. However, these data do provide some preliminary evidence that patients already taking either an ACE inhibitor or an ARB for high blood pressure may not need to stop taking these medications if they become infected with SARS-CoV-2, as some experts have suggested might be necessary.

COVID-19 and Acute Pancreatitis

The gastrointestinal (GI) involvement, including acute pancreatitis (AP) from the novel coronavirus disease-2019 (COVID-19), is increasingly being reported. Recent evidence suggests that the pathogenesis of COVID-19 is mediated by the angiotensin-converting enzyme 2 (ACE-2) receptors and transmembrane protease serine 2 (TMPRSS2) for “priming,” which is highly expressed in the pancreas. To our knowledge, there is no other reported case of AP associated with COVID-19 after the respiratory symptoms are resolved. In this article, we present a patient with COVID-19, who came with intractable epigastric pain and resolved respiratory symptoms. A diagnosis of AP complicated with COVID-19 was made after laboratory and imaging workup, which was successfully managed conservatively.