COVID-19 severity prediction based on patient risk factors and number of vaccines received

Shlomo Vinker, Ariel Israel, Alejandro A. Schäffer, Eugene Merzon, Ilan Green, Eli Magen, Avivit Golan-Cohen, Eytan Ruppin

Keywords: COVID-19, disease severity, calculator, diabetes, obesity, kidney disease

Background:
Vaccines are highly effective in preventing severe disease and death from COVID-19, and new medications that can reduce severity of disease have been approved. However, many countries are facing limited supply of vaccine doses and medications.

Research questions:
A model estimating the probabilities for hospitalization and mortality according to individual risk factors and vaccine doses received could help prioritize vaccination and yet scarce medications to maximize lives saved and reduce the burden on hospitalization facilities.

Method:
Electronic health records from 101,034 individuals infected with SARS-CoV-2, since the beginning of the pandemic and until November 30, 2021 were extracted from a national healthcare organization in Israel. Logistic regression models were built to estimate the risk for subsequent hospitalization and death based on the number of BNT162b2 mRNA vaccine doses received and few major risk factors (age, sex, body mass index, hemoglobin A1C, kidney function, and presence of hypertension, pulmonary disease or malignancy).

Results:
The models built predict the outcome of newly infected individuals with remarkable accuracy: area under the curve was 0.889 for predicting hospitalization, and 0.967 for predicting mortality. Even when a breakthrough infection occurs, having received three vaccination doses significantly reduces the risk of hospitalization by 66% (OR=0.336) and of death by 78% (OR=0.220).

Conclusions:
The models enable rapid identification of individuals at high risk for hospitalization and death when infected. These patients can be prioritized to receive booster vaccination and the yet scarce medications. A calculator based on these models is made publicly available on http://covidest.web.app

Points for discussion:
Is the calculator needs validation in other populations?

Is such a calculator can be an effective tool to a family doctor to evaluate COVID-19 severe disease risk?

How to communicate the risk to the patient?