Identification of Covid-19 risk groups to help guide treatment

Appropriate treatment pathways for coronavirus patients admitted to hospital are beginning to be refined after research data showed people were able to be divided into four distinct risk groups to better ensure the correct treatment was offered and administered.

Researchers, working on the world’s largest study of patients with the disease, identified the groups using clinical information and tests carried out on patients on arrival at hospitals across England, Wales and Scotland. The collected data was then used to predict a patient’s risk of death – ranging from low to very high.

Using these identified groupings, a Covid-19 risk identification tool has been built by the ISARIC Coronavirus Clinical Characterisation Consortium, which has been funded by NIHR and UKRI, to help support clinical staff in choosing the best course of treatment for patients admitted to hospital.

Data gathered from 35,000 patients admitted to hospital between February and May 2020 was used to understand risk groups and develop the new tool, with the research having been published in the British Medical Journal.

Data used to identify the risk category a person fit into – and by extension, their risk of dying – included measurements such as age, sex, the number of pre-existing conditions, respiratory rate on admission and the results of two blood tests.

One in every hundred patients in the low risk group was found to be at risk of dying, compared with 10 in every hundred in the intermediate group. Those percentages rose to 31 in every hundred in the high risk group and 62 in every hundred in the very high risk group.

The tool then underwent testing and was confirmed to be accurate using information from a further 22,000 patients hospitalised from the end of May to the end of June 2020.

It is though the newly-identified risk categories could be used to support treatment decisions, such as admitting patients at high risk to critical care immediately.

Dr Stephen Knight, Co-Lead Author and NIHR Clinical Research Fellow at the University of Edinburgh, said: ““This accurate and simple risk identification tool, applicable across all groups within society, will help detect at risk individuals quickly on arrival to hospital.

“As importantly, we will be able to reassure and potentially treat at home those patients who fall within the low risk group.”

Until now, there had not been an accurate tool for assessing Covid-19 patient risk. Existing tools for pneumonia or sepsis did not offer an accurate prediction due to the differences between the diseases. Similarly, previous attempts to build a risk prediction tool for Covid-19 had limited success due to small sample sizes and lack of formal validation.

There remain limitations even with this new tool in that it can only be used on hospital patients and not within the community.

Minister for Innovation Lord Bethell added: “Protecting the most vulnerable from Covid-19 is a priority, which is why we’re supporting valuable research like this to help doctors make the best possible decisions for NHS patients. I am delighted to see my former university leading the way on it.

“We look forward to seeing how this new tool can help clinicians target treatments more effectively for coronavirus patients admitted to hospital now and in the future, potentially saving countless lives.”

The ISARIC 4C study involves 260 hospitals across England, Wales and Scotland and two thirds of all people admitted to hospital with Covid-19. The NIHR Clinical Research Network has recruited almost 78,000 participants to the study, following its prioritisation through Urgent Public Health status.


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