Rapid Evaluation of Coronavirus Illness Severity (RECOILS) in intensive care: Development and validation of a prognostic tool for in-hospital mortality

Drago Plečko*, Nicolas Bennett, Johan Mårtensson, Tariq A. Dam, Robert Entjes, Thijs C.D. Rettig, Dave A. Dongelmans, Age D. Boelens, Sander Rigter, Stefaan H.A. Hendriks, Remko de Jong, Marlijn J.A. Kamps, Marco Peters, Attila Karakus, Diederik Gommers, Dharmanand Ramnarain, Evert Jan Wils, Sefanja Achterberg, Ralph Nowitzky, Walter van den TempelCornelis P.C. de Jager, Fleur G.C.A. Nooteboom, Evelien Oostdijk, Peter Koetsier, Alexander D. Cornet, Auke C. Reidinga, Wouter de Ruijter, Rob J. Bosman, Tim Frenzel, Louise C. Urlings-Strop, Paul de Jong, Ellen G.M. Smit, Olaf L. Cremer, D. Jannet Mehagnoul-Schipper, Harald J. Faber, Judith Lens, Gert B. Brunnekreef, Barbara Festen-Spanjer, Tom Dormans, Daan P. de Bruin, Robbert C.A. Lalisang, Sebastiaan J.J. Vonk, Martin E. Haan, Lucas M. Fleuren, Patrick J. Thoral, Paul W.G. Elbers, Rinaldo Bellomo

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: The prediction of in-hospital mortality for ICU patients with COVID-19 is fundamental to treatment and resource allocation. The main purpose was to develop an easily implemented score for such prediction. Methods: This was an observational, multicenter, development, and validation study on a national critical care dataset of COVID-19 patients. A systematic literature review was performed to determine variables possibly important for COVID-19 mortality prediction. Using a logistic multivariable model with a LASSO penalty, we developed the Rapid Evaluation of Coronavirus Illness Severity (RECOILS) score and compared its performance against published scores. Results: Our development (validation) cohort consisted of 1480 (937) adult patients from 14 (11) Dutch ICUs admitted between March 2020 and April 2021. Median age was 65 (65) years, 31% (26%) died in hospital, 74% (72%) were males, average length of ICU stay was 7.83 (10.25) days and average length of hospital stay was 15.90 (19.92) days. Age, platelets, PaO2/FiO2 ratio, pH, blood urea nitrogen, temperature, PaCO2, Glasgow Coma Scale (GCS) score measured within +/−24 h of ICU admission were used to develop the score. The AUROC of RECOILS score was 0.75 (CI 0.71–0.78) which was higher than that of any previously reported predictive scores (0.68 [CI 0.64–0.71], 0.61 [CI 0.58–0.66], 0.67 [CI 0.63–0.70], 0.70 [CI 0.67–0.74] for ISARIC 4C Mortality Score, SOFA, SAPS-III, and age, respectively). Conclusions: Using a large dataset from multiple Dutch ICUs, we developed a predictive score for mortality of COVID-19 patients admitted to ICU, which outperformed other predictive scores reported so far.

Original languageEnglish
Pages (from-to)65-75
Number of pages11
JournalActa Anaesthesiologica Scandinavica
Volume66
Issue number1
Early online date8 Oct 2021
DOIs
Publication statusPublished - Jan 2022

Bibliographical note

Funding Information:
Authors DP and NB are supported by the grant #2017-110 of the Strategic Focal Area ?Personalized Health and Related Technologies (PHRT)? of the ETH Domain for the SPHN/PHRT Driver Project ?Personalized Swiss Sepsis Study?. Other authors are funded by their respective institutions. From collaborating hospitals having shared data: Remko van den Akker, Intensive Care, Adrz, Goes, The Netherlands, r.vandenakker@adrz.nl; Tom A. Rijpstra, MD, Department of Intensive Care, Amphia Ziekenhuis, Breda, The Netherlands, trijpstra@amphia.nl; M.C. Reuland, MD, Department of Intensive Care Medicine, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands, m.c.reuland@amsterdamumc.nl; Klaas Sierk Arnold, MD, Anesthesiology, Antonius Ziekenhuis Sneek, Sneek, The Netherlands, k.arnold@antonius-sneek.nl; Arend Jan Meinders, MD, Department of Internal Medicine and Intensive Care, St Antonius Hospital, Nieuwegein, The Netherlands, A.meinders@antoniusziekenhuis.nl; Nicolas Schroten, MD, Intensive Care, Albert Schweitzerziekenhuis, Dordrecht, The Netherlands, nicolasschroten@gmail.com; Laura van Manen, MD, Department of Intensive Care, BovenIJ Ziekenhuis, Amsterdam, The Netherlands, l.vanmanen@bovenij.nl; Leon Montenij, MD, PhD, Department of Anesthesiology, Pain Management and Intensive Care, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands, leon.montenij@catharinaziekenhuis.nl; Julia Koeter, MD, Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands, j.koeter@cwz.nl; J.W. Fijen, MD, PhD, Department of Intensive Care, Diakonessenhuis Hospital, Utrecht, The Netherland, jwfijen@diakhuis.nl; Jasper van Bommel, MD, PhD, Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands, j.vanbommel@erasmusmc.nl; Roy van den Berg, Department of Intensive Care, ETZ Tilburg, Tilburg, The Netherlands, r.vandenberg@etz.nl; Martha de Bruin, MD, Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands, M.deBruin4@franciscus.nl; Roger van Rietschote, Business Intelligence, Haaglanden MC, Den Haag, The Netherlands, Roger.van.rietschote@haaglandenmc.nl; Ellen van Geest, Department of ICMT, Haga Ziekenhuis, Den Haag, The Netherlands, e.vangeest@hagaziekenhuis.nl; Koen S. Simons, MD, PhD, Department of Intensive Care, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands, k.simons@jbz.nl; Anisa Hana, MD, PhD, Intensive Care, Laurentius Ziekenhuis, Roermond, The Netherlands, anisa.hana@lzr.nl; Joost Labout, MD, PhD, ICU, Maasstad Ziekenhuis Rotterdam, The Netherlands, laboutj@maasstadziekenhuis.nl; Michael Kuiper, Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands, m.kuiper@mcl.nl; Albertus Beishuizen, MD, PhD, Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands, b.beishuizen@mst.nl; Bart van de Gaauw, MD, PhD, Martiniziekenhuis, Groningen, The Netherlands, b.vandergaauw@mzh.nl; Roos Renckens, MD, PhD, Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands, r.renckens@nwz.nl; B. van den Bogaard, MD, PhD, ICU, OLVG, Amsterdam, The Netherlands, b.vandenbogaard@olvg.nl; Prof. Peter Pickkers, Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands, peter.pickkers@radboudumc.nl; Pim van der Heiden, MD, PhD, Intensive Care, Reinier de Graaf Gasthuis, Delft, The Netherlands, pvdheiden@hotmail.com; Dennis Geutjes, Department of Information Technology, Slingeland Ziekenhuis, Doetinchem, The Netherlands, d.geutjes@slingeland.nl; Claudia (C.W.) van Gemeren, MD, Intensive Care, Spaarne Gasthuis, Haarlem en Hoofddorp, The Netherlands, c.van.gemeren@spaarnegasthuis.nl; Emma Rademaker, MD, MSc, Department of Intensive Care, UMC Utrecht, Utrecht, The Netherlands, E.Rademaker-2@umcutrecht.nl; Frits H.M. van Osch, PhD, Department of Clinical Epidemiology, VieCuri Medisch Centrum, Venlo, The Netherlands, fvosch@viecuri.nl; Johan Lutisan, MD, ICU, WZA, Assen, The Netherlands, johan.lutisan@wza.nl; Jacomar J.M. van Koesveld, MD, ICU, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands, jvkoesveld@ysl.nl; Bart P. Grady, MD, PhD, Department of Intensive Care, Ziekenhuisgroep Twente, Almelo, The Netherlands, b.grady@zgt.nl; and Martijn de Kruif, MD, PhD, Department of Pulmonology, Zuyderland MC, Heerlen, The Netherlands, m.dekruif@zuyderland.nl. From collaborating hospitals having signed the data sharing agreement: Bram Simons, MD, Intensive Care, Bravis Ziekenhuis, Bergen op Zoom en Roosendaal, The Netherlands, Br.simons@bravis.nl; A.A. Rijkeboer, MD, ICU, Flevoziekenhuis, Almere, The Netherlands, arijkeboer@flevoziekenhuis.nl; Annemieke Dijkstra, MD, Department of Intensive Care Medicine, Het Van Weel-Bethesda Ziekenhuis, Dirksland, The Netherlands, a.dijkstra@vanweelbethesdaziekenhuis.nl; Sesmu Arbous, MD, PhD, Intensivist, LUMC, Leiden, The Netherlands, m.s.arbous@lumc.nl; Marcel Aries, MD, PhD, MUMC+, University Maastricht, Maastricht, The Netherlands, marcel.aries@mumc.nl; Menno Beukema, MD, Department of Intensive Care, Streekziekenhuis Koningin Beatrix, Winterswijk, The Netherlands, m.beukema@skbwinterswijk.nl; Dani?l Pretorius, MD, Department of Intensive Care Medicine, Hospital St Jansdal, Harderwijk, The Netherlands, DJH.Pretorius@stjansdal.nl; Rutger van Raalte, Department of Intensive Care, Tergooi hospital, Hilversum, The Netherlands, RvanRaalte@tergooi.nl; Martijn van Tellingen, MD, EDIC, Department of Intensive Care Medicine, afdeling Intensive Care, ziekenhuis Tjongerschans, Heerenveen, The Netherlands, martijn.van.tellingen@tjongerschans.nl; Niels C. Gritters van den Oever, MD, Intensive Care, Treant Zorggroep, Emmen, The Netherlands, n.gritters@treant.nl. From the Laboratory for Critical Care Computational Intelligence: Armand R.J. Girbes, MD, PhD, EDIC, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Amsterdam, The Netherlands, arj.girbes@amsterdamumc.nl; Luca Roggeveen, MD, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, l.roggeveen@amsterdamumc.nl; Dagmar M. Ouweneel, PhD, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, d.m.ouweneel@amsterdamumc.nl; Ronald Driessen, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, r.driessen@amsterdamumc.nl; Jan Peppink, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, jan.peppink@amsterdamumc.nl; H.J. de Grooth, MD, PhD, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, h.degrooth@amsterdamumc.nl; G.J. Zijlstra, MD, PhD, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, g.j.zijlstra@amsterdamumc.nl; A.J. van Tienhoven, MD, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, a.vantienhoven@amsterdamumc.nl; Evelien van der Heiden, MD, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, e.vanderheiden@amsterdamumc.nl; Jan Jaap Spijkstra, MD, PhD, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, jj.spijkstra@amsterdamumc.nl; Hans van der Spoel, MD, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, ji.vanderspoel@amsterdamumc.nl; Angelique de Man, MD, PhD, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, ame.deman@amsterdamumc.nl; Thomas Klausch, PhD, Department of Clinical Epidemiology, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, t.klausch@amsterdamumc.nl; Heder J. de Vries, MD, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, h.vries@amsterdamumc.nl; Mark Hoogendoorn, PhD, Quantitative Data Analytics Group, Department of Computer Science, Faculty of Science, VU University, Amsterdam, The Netherlands, m.hoogendoorn@vu.nl; Fuda van Diggelen, MSc, Quantitative Data Analytics Group, Department of Computer Sciences, Faculty of Science, VU University, Amsterdam, The Netherlands, fuda.van.diggelen@vu.nl; Ali el Hassouni, PhD, Quantitative Data Analytics Group, Department of Computer Sciences, Faculty of Science, VU University, Amsterdam, The Netherlands, a.el.hassouni@vu.nl; David Romero Guzman, PhD, Quantitative Data Analytics Group, Department of Computer Sciences, Faculty of Science, VU University, Amsterdam, The Netherlands, d.w.romeroguzman@vu.nl; Sandjai Bhulai, PhD, Analytics and Optimization Group, Department of Mathematics, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands, s.bhulai@vu.nl. From Pacmed: Michele Tonutti, MRes, Pacmed, Amsterdam, The Netherlands, michele.tonutti@pacmed.nl; Mattia Fornasa, PhD, Pacmed, Amsterdam, The Netherlands, mattia.fornasa@pacmed.nl; Tomas Machado, Pacmed, Amsterdam, The Netherlands, tomas.machado@pacmed.nl; Adam Izdebski, Pacmed, Amsterdam, The Netherlands, adam.izdebski@pacmed.nl; Taco Houwert, MSc, Pacmed, Amsterdam, The Netherlands, taco.houwert@pacmed.nl; Hidde Hovenkamp, MSc, Pacmed, Amsterdam, The Netherlands, hidde@pacmed.nl; Roberto Noorduijn Londono, MSc, Pacmed, Amsterdam, The Netherlands, roberto.noorduijn@pacmed.nl; Davide Quintarelli, MSc, Pacmed, Amsterdam, The Netherlands, davide.quintarelli@pacmed.nl; Martijn G. Scholtemeijer, MD, Pacmed, Amsterdam, The Netherlands, martijn.scholtemeijer@pacmed.nl; Aletta A. de Beer, MSc, Pacmed, Amsterdam, The Netherlands, aletta.debeer@pacmed.nl; Giovanni Cin?, PhD, Pacmed, Amsterdam, The Netherlands, giovanni.cina@pacmed.nl; Willem E. Herter, BSc, Pacmed, Amsterdam, The Netherlands, willem@pacmed.nl; Michael de Neree tot Babberich, Pacmed, Amsterdam, The Netherlands, michael.deneree@pacmed.nl; Olivier Thijssens, MSc, Pacmed, Amsterdam, The Netherlands, olivier.thijssens@pacmed.nl; Lot Wagemakers, Pacmed, Amsterdam, The Netherlands, lot.wagemakers@pacmed.nl; Hilde G.A. van der Pol, Pacmed, Amsterdam, The Netherlands, hilde.vanderpol@pacmed.nl; Tom Hendriks, Pacmed, Amsterdam, The Netherlands, tom.hendriks@pacmed.nl; Julie Berend, Pacmed, Amsterdam, The Netherlands, julieberend1@gmail.com; Virginia Ceni Silva, Pacmed, Amsterdam, The Netherlands, vivicenisilva@gmail.com; Robert F.J. Kullberg, MD, Pacmed, Amsterdam, The Netherlands, bobkullberg@gmail.com. From RCCnet: Leo Heunks, MD, PhD, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, l.heunks@amsterdamumc.nl; Nicole Juffermans, MD, PhD, ICU, OLVG, Amsterdam, The Netherlands, n.p.juffermans@amsterdamumc.nl; Arjen J.C. Slooter, MD, PhD, Department of Intensive Care Medicine, UMC Utrecht, Utrecht University, Utrecht, the Netherlands, a.slooter-3@umcutrecht.nl. From other collaborating partners:Martijn Beudel, MD, PhD, Department of Neurology, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands, m.beudel@amsterdamumc.nl; Nicolet F. de Keizer, PhD, Department of Clinical Informatics, Amsterdam UMC, Amsterdam, The Netherlands, n.f.keizer@amsterdamumc.nl.

Funding Information:
Authors DP and NB are supported by the grant #2017‐110 of the Strategic Focal Area “Personalized Health and Related Technologies (PHRT)” of the ETH Domain for the SPHN/PHRT Driver Project ‘Personalized Swiss Sepsis Study’. Other authors are funded by their respective institutions.

Publisher Copyright:
© 2021 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

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