Start with a free account for 3 free CME credits. Already a subscriber? Sign in.
Free Episode

What’s That Lab? COVID-19 Labs Special Edition!

Paul Simmons, MD and Jay-Sheree Allen, MD
00:00
20:35

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

In this Hippo Education bonus, Dr. Paul Simmons and Dr. Jay-Sheree Allen sit down to discuss what lab studies are recommended on admission of a COVID patient to the hospital, which labs are followed daily, and how they’re best used.

Posted 12/21/2020


References: 

  • Click here for a summary table of the discussed labs

  • Wang D., et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020 Mar 17; 323(11):1061-1069. PMID: 32031570

  • Huang C., et al. Clinical features of patients infected with 2019 novel Coronavirus in Wuhan, China. Lancet. 2020 Feb 15; 395(10223):497-506. PMID: 31986264

  • Chen N., et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel Coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Feb 15;395(10223):507-513. PMID: 32007143

  • Zhang J-J., et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020 Jul; 75(7):1730-1741. PMID: 32077115

  • QCOVID risk score: Clift AK, et al. Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults: national derivation and validation cohort study. BMJ. 2020 Oct 20;371:m3731. PMID: 33082154

  • 4C mortality score: Knight SR, et al. Risk stratification of patients admitted to hospital with COVID-19 using the ISARIC WHO Clinical Characterization Protocol: development and validation of the 4C mortality score. BMJ. 2020 Sep 9;370:m3339. PMID: 32907855

  • COR+12 score: Laguna-Goya R, et al. IL-6-based mortality risk model for hospitalized patients with COVID-19. J Allergy Clin Immunol. 2020 Oct;146(4):799-807. PMID: 32710975

  • Seven-factor nomogram: Gong J, et al. A tool for early prediction of severe Coronavirus disease 2019 (COVID-19): a multicenter study using the risk nomogram in Wuhan and Guangdong, China. Clin Infect Dis. 2020 Jul 28;71(15):833-840. PMID: 32296824

  • CALL risk score: Ji D, et al. Prediction for progression risk in patients with COVID-19 pneumonia: the CALL score. Clin Infect Dis. 2020 Sep 12;71(6):1393-1399. PMID: 32271369

  • COVID-GRAM calculator: Liang W., et al. Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19. JAMA Intern Med. 2020 Aug 1;180(8):1081-1089. PMID: 32396163

  • Elevated D-dimers and lack of anticoagulation predict PE in severe COVID-19 patients. Basile Mouhat, et al. European Respiratory Journal 2020; DOI: 10.1183/13993003.01811-2020. PMID: 32907890

Whitney B. -

Thank you for the great piece! I work strictly outpatient, but it's always nice to understand what our colleagues in the hospital are doing. When I looked up the risk scores, it looks like they are all meant to be used in-patient. Do you know of any evidence for using these labs to risk-stratify outpatients, or predict their odds of hospitalization?

Neda F., MD -

Hello, Whitney:

Thanks for your excellent question, and I (Paul) apologize for kind of ignoring a key area we should’ve mentioned - the outpatient setting!

What I have found is this:

1. The CoVA score: a prospectively validated score using age, diastolic BP, O2 sat, and respiratory rate (in addition to being COVID positive) as a predictor of hospitalization, critical illness, and death. The study from October 2020 can be found here: J Infect Dis 2020 Oct 24;jiaa663. A couple of interesting observations regarding CoVA:
A. The authors say their model did NOT find that diabetes nor hypertension were predictors of serious disease! What?!
B. Try as I might, I have not been able to find a nice, easy plug-in-the-values version of CoVA online. Sorry if I overlooked something, and let us know if you find it! It’s not on MDCalc yet or any of the similar platforms.

2. Another interesting model was published in The Lancet on 1 October 2020 (vol 2, issue 10) in which outpatient vs inpatient evaluation - that is, the setting in which the patient was seen - was used as a risk predictor. As one would guess, patients being seen via telehealth or in the clinic tend to be healthier than those being seen in the ED. On average!

But so far, the CoVA score seems to be the main score used for outpatient prediction. As you noted, pretty much every other score is trying to predict outcomes in inpatients (the CoVA paper authors actually included a chart of all the other COVID risk scores to date, and they’re all inpatient!).

Thanks again for your question and for listening!

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
What’s That Lab? COVID-19 Labs Special Edition Chart 80 KB - PDF