Derivation and external validation of a simple risk score to predict in-hospital mortality in patients hospitalized for COVID-19: A multicenter retrospective cohort study

ABSTRACT: As severe acute respiratory syndrome coronavirus 2 continues to spread, easy-to-use risk models that predict hospital mortality can assist in clinical decision making and triage. We aimed to develop a risk score model for in-hospital mortality in patients hospitalized with 2019 novel coronavirus (COVID-19) that was robust across hospitals and used clinical factors that are readily available and measured standardly across hospitals. In this retrospective observational study, we developed a risk score model using data collected by trained abstractors for patients in 20 diverse hospitals across the state of Michigan (Mi-COVID19) who were discharged between March 5, 2020 and August 14, 2020. Patients who tested positive for severe acute respiratory syndrome coronavirus 2 during hospitalization or were discharged with an ICD-10 code for COVID-19 (U07.1) were included. We employed an iterative forward selection approach to consider the inclusion of 145 potential risk factors available at hospital presentation. Model performance was externally validated with patients from 19 hospitals in the Mi-COVID19 registry not used in model development. We shared the model in an easy-to-use online application that allows the user to predict in-hospital mortality risk for a patient if they have any subset of the variables in the final model. Two thousand one hundred and ninety-three patients in the Mi-COVID19 registry met our inclusion criteria. The derivation and validation sets ultimately included 1690 and 398 patients, respectively, with mortality rates of 19.6% and 18.6%, respectively. The average age of participants in the study after exclusions was 64 years old, and the participants were 48% female, 49% Black, and 87% non-Hispanic. Our final model includes the patient\u27s age, first recorded respiratory rate, first recorded pulse oximetry, highest creatinine level on day of presentation, and hospital\u27s COVID-19 mortality rate. No other factors showed sufficient incremental model improvement to warrant inclusion. The area under the receiver operating characteristics curve for the derivation and validation sets were .796 (95% confidence interval, .767-.826) and .829 (95% confidence interval, .782-.876) respectively. We conclude that the risk of in-hospital mortality in COVID-19 patients can be reliably estimated using a few factors, which are standardly measured and available to physicians very early in a hospital encounter

WISE J072003.20-084651.2B Is A Massive T Dwarf

We present individual dynamical masses for the nearby M9.5+T5.5 binary WISE J072003.20$-$084651.2AB, a.k.a. Scholz's star. Combining high-precision CFHT/WIRCam photocenter astrometry and Keck adaptive optics resolved imaging, we measure the first high-quality parallactic distance ($6.80_{-0.06}^{+0.05}$ pc) and orbit ($8.06_{-0.25}^{+0.24}$ yr period) for this system composed of a low-mass star and brown dwarf. We find a moderately eccentric orbit ($e = 0.240_{-0.010}^{+0.009}$), incompatible with previous work based on less data, and dynamical masses of $99\pm6$ $M_{\rm Jup}$ and $66\pm4$ $M_{\rm Jup}$ for the two components. The primary mass is marginally inconsistent (2.1$\sigma$) with the empirical mass$-$magnitude$-$metallicity relation and models of main-sequence stars. The relatively high mass of the cold ($T_{\rm eff} = 1250\pm40$ K) brown dwarf companion indicates an age older than a few Gyr, in accord with age estimates for the primary star, and is consistent with our recent estimate of $\approx$70 $M_{\rm Jup}$ for the stellar/substellar boundary among the field population. Our improved parallax and proper motion, as well as an orbit-corrected system velocity, improve the accuracy of the system's close encounter with the solar system by an order of magnitude. WISE J0720$-$0846AB passed within $68.7\pm2.0$ kAU of the Sun $80.5\pm0.7$ kyr ago, passing through the outer Oort cloud where comets can have stable orbits.Comment: accepted to A

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes