Development and Validation of an Acute Respiratory Distress Syndrome Prediction Model in Coronavirus Disease 2019: Updated Lung Injury Prediction Score

Objective: To develop and validate an updated lung injury prediction score for coronavirus disease 2019 (COVID-19) (c-LIPS) tailored for predicting acute respiratory distress syndrome (ARDS) in COVID-19.Patients and Methods: This was a registry-based cohort study using the Viral Infection and Respi-ratory Illness Universal Study. Hospitalized adult patients between January 2020 and January 2022 were screened. Patients who qualified for ARDS within the first day of admission were excluded. Development cohort consisted of patients enrolled from participating Mayo Clinic sites. The validation analyses were performed on remaining patients enrolled from more than 120 hospitals in 15 countries. The original lung injury prediction score (LIPS) was calculated and enhanced using reported COVID-19especific laboratory risk factors, constituting c-LIPS. The main outcome was ARDS development and secondary outcomes included hospital mortality, invasive mechanical ventilation, and progression in WHO ordinal scale.Results: The derivation cohort consisted of 3710 patients, of whom 1041 (28.1%) developed ARDS. The c-LIPS discriminated COVID-19 patients who developed ARDS with an area under the curve (AUC) of 0.79 compared with original LIPS (AUC, 0.74; P<.001) with good calibration accuracy (Hosmer-Lemeshow P1/4.50). Despite different characteristics of the two cohorts, the c-LIPS's per-formance was comparable in the validation cohort of 5426 patients (15.9% ARDS), with an AUC of 0.74; and its discriminatory performance was significantly higher than the LIPS (AUC, 0.68; P<.001). The c-LIPS's performance in predicting the requirement for invasive mechanical ventilation in deri-vation and validation cohorts had an AUC of 0.74 and 0.72, respectively.Conclusion: In this large patient sample c-LIPS was successfully tailored to predict ARDS in COVID-19 patients. (c) 2023 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved

Automated summary

Objective: To develop and validate a lung injury prediction score (c-LIPS) tailored for predicting Acute Respiratory Distress Syndrome (ARDS) in COVID-19 patients. Methods: A registry-based cohort study was conducted using the Viral Infection and Respiratory Illness Universal Study. The c-LIPS score was developed using COVID-19-specific laboratory risk factors and validated in a large cohort of patients from multiple countries. Results: The c-LIPS score showed good discriminatory performance in predicting ARDS development and the need for invasive mechanical ventilation. Conclusion: The c-LIPS score can successfully predict ARDS in COVID-19 patients and may be a useful tool for clinicians.