COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Clinical Prediction Guide Xu R, Hou K, Zhang K, et al. Performance of Two Risk-Stratification Models in Hospitalized Patients With Coronavirus Disease. Front Med (Lausanne). 2020 Aug 14;7:518. doi: 10.3389/fmed.2020.00518. eCollection 2020.

Background: Despite an increase in the familiarity of the medical community with the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19), there is presently a lack of rapid and effective risk stratification indicators to predict the poor clinical outcomes of COVID-19 especially in severe patients. Methods: In this retrospective single-center study, we included 117 cases confirmed with COVID-19. The clinical, laboratory, and imaging features were collected and analyzed during admission. The Multi-lobular infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension and Age (MuLBSTA) Score and Confusion, Urea, Respiratory rate, Blood pressure, Age 65 (CURB65) score were used to assess the death and intensive care unit (ICU) risks in all patients. Results: Among of all 117 hospitalized patients, 21 (17.9%) patients were admitted to the ICU care, and 5 (4.3%) patients were died. The median hospital stay was 12 (10-15) days. There were 18 patients with MuLBSTA score = 12 points and were all of severe type. In severe type, ICU care and death patients, the proportion with MuLBSTA = 12 points were greater than that of CURB65 score = 3 points (severe type patients, 50 vs. 27.8%; ICU care, 61.9 vs. 19.0%; death, 100 vs. 40%). For the MuLBSTA score, the ROC curve showed good efficiency of diagnosis death (area under the curve [AUC], 0.956; cutoff value, 12; specificity, 89.5%; sensitivity, 100%) and ICU care (AUC, 0.875; cutoff value, 11; specificity, 91.7%; sensitivity, 71.4%). The K-M survival analysis showed that patients with MuLBSTA score = 12 had higher risk of ICU (log-rank, P = 0.001) and high risk of death (log-rank, P = 0.000). Conclusions: The MuLBSTA score is valuable for risk stratification and could effectively screen high-risk patients at admission. The higher score at admission have higher risk of ICU care and death in patients infected with COVID.

Discipline / Specialty Area Score
Infectious Disease
Intensivist/Critical Care
Comments from MORE raters

Infectious Disease rater

This article examines the validity of the MulBSTA score in patients with COVID-19. This is a relatively new score aiming to give prognostic information on viral pneumonia. It needs to be validated in larger and diverse samples of patients. Until then, it can be used as a rough guide rather than a accurate prognostic tool.

Intensivist/Critical Care rater

Scoring sydtems for severity and outcome are useful but the number of patients in this study is small given the magnitude of the problem. The information is of relatively little clinical application and decision making.