Adaptation of the WHO COVID-19 Clinical Progression Scale for Registry-Based Data: A Whole-Population Study in Sweden.

IF 3.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology Pub Date : 2025-07-15 eCollection Date: 2025-01-01 DOI:10.2147/CLEP.S525030

Hanna Jerndal, Sebastian Kalucza, Frida Jakobsson, Anders Hviid, Tyra Grove Krause, Clas Ahlm, Johan Normark, Osvaldo Fonseca-Rodríguez, Marie Eriksson, Anne-Marie Fors Connolly

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引用次数: 0

Abstract

Purpose: COVID-19 has been extensively researched; however, the lack of standardized COVID-19 severity categorization in register-based research complicates comparison of studies. The WHO COVID-19 Clinical Progression Scale is a standardized disease severity tool for clinical data, though not adapted to data available in health registries. We aimed to develop and validate such a novel categorization with international applicability.

Methods: The WHO Clinical Progression Scale was translated to a severity index utilizing ICD- and procedure-codes from outpatient, inpatient, intensive care, and mortality registries using the adult Swedish population and SARS-CoV-2 positive-test data (January 2020 - July 2022). Cox proportional hazards were applied to determine whether increasing severity correlates with mortality in COVID-19 patients compared to the population.

Results: The WHO-Scale was translated to ten categories reflecting the increasing need for advanced care, encompassing 8,245,474 individuals including 1,981,946 SARS-CoV-2 infections. Fatal COVID-19 cases were older with more comorbidities. Those receiving mechanical ventilation and ECMO were younger with fewer comorbidities. Among survivors beyond 30 days, 90-day all-cause mortality increased with severity using category zero (no laboratory-verified SARS-CoV-2) as reference. Mortality was lowest for patients without health care adjusted for age, sex, comorbidities and socio-economic variables (adjusted hazard ratio (aHR) 1.18, 95% confidence interval (CI) 1.13-1.22). Those hospitalized >5 days had higher mortality (aHR 5.83, 5.5-6.17). Those requiring ECMO/ECLS had the highest mortality (aHR 593.54, 317.77-1108.65).

Conclusion: The novel COVID-19 severity index associated with all-cause 90-day mortality and aligned with previous literature. This index will enable comparative studies of COVID-19, which is important for public health policies and development of clinical guidelines. This is an innovative epidemiologic tool with potential applicability in all countries with centralised health registers. The index also has the potential to be used for other infectious diseases and in real-time data for modelling predictions.

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世卫组织COVID-19临床进展量表适用于基于登记的数据：瑞典的一项全人群研究

目的：对COVID-19进行广泛研究；然而，在基于登记册的研究中缺乏标准化的COVID-19严重程度分类，使研究的比较复杂化。世卫组织COVID-19临床进展量表是用于临床数据的标准化疾病严重程度工具，但尚未适应卫生登记中现有的数据。我们的目标是开发和验证这种具有国际适用性的新分类。方法：利用来自门诊、住院、重症监护和死亡率登记处的ICD和程序代码，利用瑞典成年人口和SARS-CoV-2阳性检测数据（2020年1月至2022年7月），将世卫组织临床进展量表转化为严重程度指数。应用Cox比例风险来确定与人群相比，COVID-19患者的严重程度增加是否与死亡率相关。结果：世卫组织量表被翻译成十个类别，反映出对高级护理的需求日益增加，涉及8,245,474人，其中包括1,981,946名SARS-CoV-2感染者。致命的COVID-19病例年龄较大，合并症较多。接受机械通气和ECMO的患者更年轻，合并症更少。在30天以上的幸存者中，以零类（没有实验室验证的SARS-CoV-2）为参照，90天的全因死亡率随严重程度而增加。经年龄、性别、合并症和社会经济变量调整后，无医疗保健的患者死亡率最低（调整风险比（aHR） 1.18, 95%置信区间（CI） 1.13-1.22）。住院5 d死亡率较高（aHR 5.83, 5.5 ~ 6.17）。需要ECMO/ECLS的患者死亡率最高（aHR 593.54, 317.77-1108.65）。结论：新型COVID-19严重程度指数与全因90天死亡率相关，与既往文献一致。该指数将有助于对COVID-19进行比较研究，这对公共卫生政策和临床指南的制定至关重要。这是一种创新的流行病学工具，可能适用于所有拥有集中卫生登记的国家。该指数也有可能用于其他传染病，并用于建模预测的实时数据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.