17 Nov Intermountain Risk Score to Predict Major Adverse Health Events in Patients Positive for SARS-CoV-2 in 2020

MedicalResearch.com Interview with:

Dr. Horne

Benjamin D. Horne, PhD
Cardiovascular and Genetic Epidemiologist
Intermoumtain Health

MedicalResearch.com: What is the background for this study?

Response: The Intermountain Mortality Risk Score (IMRS) is a risk prediction tool developed in 2009 and repeatedly validated over the last decade to predict death, major adverse health events such as heart attack and stroke, and the onset of major chronic diseases. IMRS is computed using sex-specific weightings of parameters from the complete blood count (CBC) and basic metabolic profile (BMP), and age. The CBC and BMP are commonly-ordered clinical laboratory panels that include hemoglobin, white blood cell count, glucose, creatinine, sodium, calcium, and other factors whose testing is standardized and the results are objective and quantitative with no need to know what diagnoses a patient may have. IMRS is known to be a superior predictor of death compared to comorbidity-based risk scores and has been found to predict health outcomes in people with no chronic disease diagnoses as well as patients with coronary heart disease, atrial fibrillation, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, and various other diagnoses. IMRS has not been evaluated as a predictor of health outcomes for people with COVID-19, but if it does it could be useful for people to use to evaluate their own risk of poor outcomes if they are infected with SARS-CoV-2, for clinical personnel to guide the care of patients with COVID-19, and for public health professionals to use to determine who among those never diagnosed with COVID-19 is at higher risk of poor health outcomes and should be the first to receive a COVID-19 immunization. 

MedicalResearch.com: What are the main findings?

Response: This study evaluated more than 1,000 patients diagnosed with COVID-19 at Intermountain Healthcare and it revealed that IMRS was exceptionally predictive of poor health outcomes such as hospitalization for COVID-19 and death due to COVID-19. This was the case when IMRS was calculated using CBC and BMP results from 2019, which was prior to the advent of SARS-CoV-2 in the USA. It was also the case when IMRS was calculated using CBC and BMP results measured at the time of COVID-19 diagnosis in 2020.

MedicalResearch.com: What should readers take away from your report?

Response: Many scientists are working right now to discover and report the factors that predict poor health outcomes for people who are infected by SARS-CoV-2 and develop COVID-19. Those research efforts are primarily focused on conditions, risk factors, and diseases that people have already been diagnosed with, such as obesity, diabetes, and conditions involving blood clots. Such comorbidities are helpful in identifying risk, but must be diagnosed by a physician to ensure that it is really the comorbidity that medical professionals are evaluating and these diagnoses do not go away even when someone is treated by medications and lifestyle changes to improve their health.

A more objective approach to evaluating risk from COVID-19 is to use a laboratory risk predictors such as the CBC and BMP parameters to measure risk. Because those laboratory values change when someone is infected by a bacteria or virus such as SARS-CoV-2, we used values from 2019 as the primary approach so that the laboratory results would reflect a time before any of the patients had been infected by this new virus. This study indicates that IMRS can be used to differentiate between people who likely will have few if any symptoms when they have COVID-19 and those who may need significant hospital resources or may die if they are diagnosed with COVID-19. Because the CBC and BMP are so commonly used in medicine, many people already have results of these tests from the last few years that they could use to check their risk level using our free “Intermountain Risk Scores Calculator” (see: https://intermountainhealthcare.org/riskscores).

Public Health professionals and those providing newly-developed COVID immunizations could also use IMRS to identify which people are the highest risk of death or sever health outcomes and should be the first to receive the immunization as production of immunizations occurs over the next year.

Finally, the results of the study do indicate that CBC and BMP laboratory results measured at the time of COVID-19 diagnosis were predictive of poor outcomes. Physicians could use IMRS measured at the time of diagnosis of COVID-19 to identify those whose risk is moderate or high and should be admitted to the hospital from an emergency room rather than sent home (or re-contacted at home and asked to come to the hospital if the patient was tested at a mobile COVID-19 test site), even if they are not yet experiencing shortness of breath or other major symptoms of COVID-19.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Further research will evaluate IMRS in a larger population of patients who test positive for COVID-19 and will attempt to derive COVID-related weightings of the CBC and BMP factors that might better identify those at high risk of poor health outcomes.

Disclosures: Drs. Horne, May, Anderson, and Ronnow are inventors of risk prediction scores (including IMRS) that are licensed to CareCentra and Alluceo, and Dr. Horne is the principal investigator of research grants related to risk prediction scores that were funded in whole or part by CareCentra, AstraZeneca, and GlaxoSmithKline, and is a member of the scientific advisory board of Labme.ai.

Citation:

AHA 2020 abstract:

Ability of the Intermountain Risk Score Measured in 2019 (pre-COVID) to Predict Major Adverse Health Events in Patients Positive for SARS-CoV-2 in 2020

https://www.ahajournals.org/doi/10.1161/circ.142.suppl_3.16681

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Last Updated on November 17, 2020 by Marie Benz MD FAAD