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Eythorsson E, Bjarnadottir V, Runolfsdottir HL, Helgason D, Ingvarsson RF, Bjornsson HK, Olafsdottir LB, Bjarnadottir S, Agustsson AS, Oskarsdottir K, Thorvaldsson HH, Kristjansdottir G, Bjornsson AH, Emilsdottir AR, Armannsdottir B, Gudlaugsson O, Hansdottir S, Gottfredsson M, Bjarnason A, Sigurdsson MI, Indridason OS, Palsson R. Development of a prognostic model of COVID-19 severity: a population-based cohort study in Iceland. Diagn Progn Res 2022; 6:17. [PMID: 36071509 PMCID: PMC9451645 DOI: 10.1186/s41512-022-00130-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 06/21/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The severity of SARS-CoV-2 infection varies from asymptomatic state to severe respiratory failure and the clinical course is difficult to predict. The aim of the study was to develop a prognostic model to predict the severity of COVID-19 in unvaccinated adults at the time of diagnosis. METHODS All SARS-CoV-2-positive adults in Iceland were prospectively enrolled into a telehealth service at diagnosis. A multivariable proportional-odds logistic regression model was derived from information obtained during the enrollment interview of those diagnosed between February 27 and December 31, 2020 who met the inclusion criteria. Outcomes were defined on an ordinal scale: (1) no need for escalation of care during follow-up; (2) need for urgent care visit; (3) hospitalization; and (4) admission to intensive care unit (ICU) or death. Missing data were multiply imputed using chained equations and the model was internally validated using bootstrapping techniques. Decision curve analysis was performed. RESULTS The prognostic model was derived from 4756 SARS-CoV-2-positive persons. In total, 375 (7.9%) only required urgent care visits, 188 (4.0%) were hospitalized and 50 (1.1%) were either admitted to ICU or died due to complications of COVID-19. The model included age, sex, body mass index (BMI), current smoking, underlying conditions, and symptoms and clinical severity score at enrollment. On internal validation, the optimism-corrected Nagelkerke's R2 was 23.4% (95%CI, 22.7-24.2), the C-statistic was 0.793 (95%CI, 0.789-0.797) and the calibration slope was 0.97 (95%CI, 0.96-0.98). Outcome-specific indices were for urgent care visit or worse (calibration intercept -0.04 [95%CI, -0.06 to -0.02], Emax 0.014 [95%CI, 0.008-0.020]), hospitalization or worse (calibration intercept -0.06 [95%CI, -0.12 to -0.03], Emax 0.018 [95%CI, 0.010-0.027]), and ICU admission or death (calibration intercept -0.10 [95%CI, -0.15 to -0.04] and Emax 0.027 [95%CI, 0.013-0.041]). CONCLUSION Our prognostic model can accurately predict the later need for urgent outpatient evaluation, hospitalization, and ICU admission and death among unvaccinated SARS-CoV-2-positive adults in the general population at the time of diagnosis, using information obtained by telephone interview.
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Affiliation(s)
- Elias Eythorsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
| | | | | | - Dadi Helgason
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Helgi K Bjornsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | | | | | | | | | | | - Arna R Emilsdottir
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Olafur Gudlaugsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sif Hansdottir
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Magnus Gottfredsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Agnar Bjarnason
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Martin I Sigurdsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Runolfur Palsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
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Eythorsson E, Helgason D, Ingvarsson RF, Bjornsson HK, Olafsdottir LB, Bjarnadottir V, Runolfsdottir HL, Bjarnadottir S, Agustsson AS, Oskarsdottir K, Thorvaldsson HH, Kristjansdottir G, Armannsdottir B, Bjarnason A, Johannsson B, Gudlaugsson O, Gottfredsson M, Sigurdsson MI, Indridason OS, Palsson R. Clinical spectrum of coronavirus disease 2019 in Iceland: population based cohort study. BMJ 2020; 371:m4529. [PMID: 33268329 PMCID: PMC7708618 DOI: 10.1136/bmj.m4529] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To characterise the symptoms of coronavirus disease 2019 (covid-19). DESIGN Population based cohort study. SETTING Iceland. PARTICIPANTS All individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) between 17 March and 30 April 2020. Cases were identified by three testing strategies: targeted testing guided by clinical suspicion, open invitation population screening based on self referral, and random population screening. All identified cases were enrolled in a telehealth monitoring service, and symptoms were systematically monitored from diagnosis to recovery. MAIN OUTCOME MEASURES Occurrence of one or more of 19 predefined symptoms during follow-up. RESULTS Among 1564 people positive for SARS-CoV-2, the most common presenting symptoms were myalgia (55%), headache (51%), and non-productive cough (49%). At the time of diagnosis, 83 (5.3%) individuals reported no symptoms, of whom 49 (59%) remained asymptomatic during follow-up. At diagnosis, 216 (14%) and 349 (22%) people did not meet the case definition of the Centers for Disease Control and Prevention and the World Health Organization, respectively. Most (67%) of the SARS-CoV-2-positive patients had mild symptoms throughout the course of their disease. CONCLUSION In the setting of broad access to RT-PCR testing, most SARS-CoV-2-positive people were found to have mild symptoms. Fever and dyspnoea were less common than previously reported. A substantial proportion of SARS-CoV-2-positive people did not meet recommended case definitions at the time of diagnosis.
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Affiliation(s)
- Elias Eythorsson
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
| | - Dadi Helgason
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
| | | | - Helgi K Bjornsson
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
| | | | - Valgerdur Bjarnadottir
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
| | | | - Solveig Bjarnadottir
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Arnar Snaer Agustsson
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
| | - Kristin Oskarsdottir
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
| | | | - Gudrun Kristjansdottir
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Brynja Armannsdottir
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
| | - Agnar Bjarnason
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Birgir Johannsson
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
| | - Olafur Gudlaugsson
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
| | - Magnus Gottfredsson
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Martin I Sigurdsson
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Olafur S Indridason
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
| | - Runolfur Palsson
- Landspitali-National University Hospital of Iceland, Hringbraut 101, 101 Reykjavík, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
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Thorvaldsson HH, Vidarsson B, Sveinsdottir SV, Olafsson GB, Halldorsdottir AM. Red blood cell utilization and transfusion triggers in patients diagnosed with chronic lymphocytic leukaemia in Iceland 2003-2016. Vox Sang 2019; 114:495-504. [PMID: 30972770 DOI: 10.1111/vox.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Revised Icelandic guidelines proposed a restrictive haemoglobin (Hb) threshold of 70 g/l for red blood cell (RBC) transfusions in general, but 100 g/l for malignancies/bone marrow suppression. Chronic lymphocytic leukaemia (CLL) is frequently complicated by anaemia. The objective was to investigate RBC transfusion practices in CLL. MATERIALS AND METHODS This retrospective nation-wide study utilized an Icelandic registry of CLL patients diagnosed between 2003 and 2016. Medical records were reviewed and haemoglobin transfusion triggers compared for two periods: Earlier (2003-2012) and latter (2013-2017). RESULTS Two hundred and thirteen patients were diagnosed with CLL over the period whereof 77 (36·2%) received RBC transfusion(s). Median time from diagnosis to first transfusion was 2·2 years. Higher age, Rai stage 3/4 at diagnosis (P < 0·05) and chemotherapy (P < 0·001) were associated with increased odds of transfusions. Shorter time to first transfusion correlated with higher age (P < 0·001) and Rai stage (P = 0·02) at diagnosis. The mean Hb trigger was 90·4 and 81·2 in the earlier and latter period respectively (P = 0·01). This difference in Hb triggers was most pronounced in patients without documented bone marrow involvement, or 80·5 g/l compared to 93·5 g/l (P = 0·004). The median time from diagnosis to transfusion was longer in the latter period (2·9 years vs. 1·6 years, P = 0·01). After RBC transfusions the survival decreased significantly (P < 0·001). CONCLUSION One-third of CLL patients received RBC transfusions but few were heavily transfused. Older age, Rai stage, and chemotherapy predicted RBC use. The Hb transfusion trigger decreased over time while time to first RBC transfusion increased. RBC transfusions predict poor survival.
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Affiliation(s)
| | - Brynjar Vidarsson
- Department of Hematology, Landspitali National University Hospital of Iceland, Reykjavik, Iceland
| | - Signy Vala Sveinsdottir
- Department of Hematology, Landspitali National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Anna Margret Halldorsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Blood Bank, Landspitali National University Hospital of Iceland, Reykjavik, Iceland
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