Development and validation of the HNC-LL score for predicting the severity of coronavirus disease 2019.
BACKGROUND
Information regarding risk factors associated with severe coronavirus disease (COVID-19) is limited. This study aimed to develop a model for predicting COVID-19 severity.


METHODS
Overall, 690 patients with confirmed COVID-19 were recruited between 1 January and 18 March 2020 from hospitals in Honghu and Nanchang; finally, 442 patients were assessed. Data were categorised into the training and test sets to develop and validate the model, respectively.


FINDINGS
A predictive HNC-LL (Hypertension, Neutrophil count, C-reactive protein, Lymphocyte count, Lactate dehydrogenase) score was established using multivariate logistic regression analysis. The HNC-LL score accurately predicted disease severity in the Honghu training cohort (area under the curve [AUC]=0.861, 95% confidence interval [CI]: 0.800-0.922; P<0.001); Honghu internal validation cohort (AUC=0.871, 95% CI: 0.769-0.972; P<0.001); and Nanchang external validation cohort (AUC=0.826, 95% CI: 0.746-0.907; P<0.001) and outperformed other models, including CURB-65 (confusion, uraemia, respiratory rate, BP, age ≥65 years) score model, MuLBSTA (multilobular infiltration, hypo-lymphocytosis, bacterial coinfection, smoking history, hypertension, and age) score model, and neutrophil-to-lymphocyte ratio model. The clinical significance of HNC-LL in accurately predicting the risk of future development of severe COVID-19 was confirmed.


INTERPRETATION
We developed an accurate tool for predicting disease severity among COVID-19 patients. This model can potentially be used to identify patients at risks of developing severe disease in the early stage and therefore guide treatment decisions.


FUNDING
This work was supported by the National Nature Science Foundation of China (grant no. 81972897) and Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme (2015).
['Xiao|Lu-Shan|LS|', 'Zhang|Wen-Feng|WF|', 'Gong|Meng-Chun|MC|', 'Zhang|Yan-Pei|YP|', 'Chen|Li-Ya|LY|', 'Zhu|Hong-Bo|HB|', 'Hu|Chen-Yi|CY|', 'Kang|Pei|P|', 'Liu|Li|L|', 'Zhu|Hong|H|']
D000073640:Betacoronavirus D002097:C-Reactive Protein D000086382:COVID-19 D018352:Coronavirus Infections D000080424:Cytokine Release Syndrome D005260:Female D006801:Humans D006973:Hypertension D007770:L-Lactate Dehydrogenase D018655:Lymphocyte Count D008297:Male D008875:Middle Aged D009504:Neutrophils D058873:Pandemics D011024:Pneumonia, Viral D011379:Prognosis D012189:Retrospective Studies D000086402:SARS-CoV-2 D012720:Severity of Illness Index
HNC-LL Prediction Severity COVID-19 SARS-COV-2