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    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

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    Author
    Lundon, DJ; Kelly, BD; Shukla, D; Bolton, DM; Wiklund, P; Tewari, A
    Date
    2020-09-01
    Source Title
    Journal of Clinical Medicine
    Publisher
    MDPI
    University of Melbourne Author/s
    Bolton, Damien
    Affiliation
    Surgery (Austin & Northern Health)
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Lundon, D. J., Kelly, B. D., Shukla, D., Bolton, D. M., Wiklund, P. & Tewari, A. (2020). 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. JOURNAL OF CLINICAL MEDICINE, 9 (9), https://doi.org/10.3390/jcm9092799.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/252956
    DOI
    10.3390/jcm9092799
    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.

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