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Title: A Decision Aide for the Risk Stratification of GU Cancer Patients at Risk of SARS-CoV-2 Infection, COVID-19 Related Hospitalization, Intubation, and Mortality.
Austin Authors: Lundon, Dara J;Kelly, Brian D ;Shukla, Devki;Bolton, Damien M ;Wiklund, Peter;Tewari, Ash
Affiliation: Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, NY 10029, USA
Issue Date: 30-Aug-2020
Date: 2020-08-30
Publication information: Journal of Clinical Medicine 2020; 9(9): E2799
Abstract: Treatment decisions for both early and advanced genitourinary (GU) malignancies take into account the risk of dying from the malignancy as well as the risk of death due to other causes such as other co-morbidities. COVID-19 is a new additional and immediate risk to a patient's morbidity and mortality and there is a need for an accurate assessment as to the potential impact on of this syndrome on GU cancer patients. The aim of this work was to develop a risk tool to identify GU cancer patients at risk of diagnosis, hospitalization, intubation, and mortality from COVID-19. A retrospective case showed a series of GU cancer patients screened for COVID-19 across the Mount Sinai Health System (MSHS). Four hundred eighty-four had a GU malignancy and 149 tested positive for SARS-CoV-2. Demographic and clinical variables of >38,000 patients were available in the institutional database and were utilized to develop decision aides to predict a positive SARS-CoV-2 test, as well as COVID-19-related hospitalization, intubation, and death. A risk tool was developed using a combination of machine learning methods and utilized BMI, temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation. The risk tool for predicting a diagnosis of SARS-CoV-2 had an AUC of 0.83, predicting hospitalization for management of COVID-19 had an AUC of 0.95, predicting patients requiring intubation had an AUC of 0.97, and for predicting COVID-19-related death, the risk tool had an AUC of 0.79. The models had an acceptable calibration and provided a superior net benefit over other common strategies across the entire range of threshold probabilities.
DOI: 10.3390/jcm9092799
ORCID: 0000-0002-5145-6783
Journal: Journal of Clinical Medicine
PubMed URL: 32872607
ISSN: 2077-0383
Type: Journal Article
Subjects: COVID-19
decision curve analysis
genito-urinary cancer
risk calculator
urologic oncology
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