COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Clinical Prediction Guide Soto-Mota A, Marfil-Garza BA, Martinez Rodriguez E, et al. The low-harm score for predicting mortality in patients diagnosed with COVID-19: A multicentric validation study. J Am Coll Emerg Physicians Open. 2020 Oct 15. pii: EMP212259. doi: 10.1002/emp2.12259.
Abstract

Objective: We sought to determine the accuracy of the LOW-HARM score (Lymphopenia, Oxygen saturation, White blood cells, Hypertension, Age, Renal injury, and Myocardial injury) for predicting death from coronavirus disease 2019) COVID-19.

Methods: We derived the score as a concatenated Fagan's nomogram for Bayes theorem using data from published cohorts of patients with COVID-19. We validated the score on 400 consecutive COVID-19 hospital admissions (200 deaths and 200 survivors) from 12 hospitals in Mexico. We determined the sensitivity, specificity, and predictive values of LOW-HARM for predicting hospital death.

Results: LOW-HARM scores and their distributions were significantly lower in patients who were discharged compared to those who died during their hospitalization 5 (SD: 14) versus 70 (SD: 28). The overall area under the curve for the LOW-HARM score was 0.96, (95% confidence interval: 0.94-0.98). A cutoff > 65 points had a specificity of 97.5% and a positive predictive value of 96%.

Conclusions: The LOW-HARM score measured at hospital admission is highly specific and clinically useful for predicting mortality in patients with COVID-19.

Ratings
Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Intensivist/Critical Care
Comments from MORE raters

Infectious Disease rater

The paper is a part of a rapidly growing research about COVID-19. Still most of these papers can not be considered a final answer of the question. There is a lot of work to do to reach real scientific answers to many questions related to COVID-19.

Intensivist/Critical Care rater

Prognostic tools are always important and although this one has promising characteristics, it is still a relatively small validation cohort and of questionable applicability given it was derived in a single healthcare system in Mexico.

Intensivist/Critical Care rater

Concise score that should be useful for department or hospital comparisons.

Internal Medicine rater

Variables in the LOW-HARM score make intuitive sense about prognosis. This might help where resources are scarce.

Internal Medicine rater

There are multiple scoring systems we use like SOFA and MSOFA to help us objectively assess prognosis. These scores can be very helpful, especially in contingency and crisis care situations. LOWHARM could be potentially used as one of these scoring systems using different variables. I am also interested to know how comparable these scoring systems are.