On March 11, 2020, WHO characterised the COVID-19 outbreak as a pandemic. It was first identified in Wuhan, China, on Decem five months later, more than six million cases had been identified across 215 countries. All rights reserved.We included 207 studies and found high or moderate certainty that the following 49 variables provide valuable prognostic information on mortality and/or severe disease in patients with COVID-19 infectious disease: Demographic factors (age, male sex, smoking), patient history factors (comorbidities, cerebrovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, cardiovascular disease, cardiac arrhythmia, arterial hypertension, diabetes, dementia, cancer and dyslipidemia), physical examination factors (respiratory failure, low blood pressure, hypoxemia, tachycardia, dyspnea, anorexia, tachypnea, haemoptysis, abdominal pain, fatigue, fever and myalgia or arthralgia), laboratory factors (high blood procalcitonin, myocardial injury markers, high blood White Blood Cell count (WBC), high blood lactate, low blood platelet count, plasma creatinine increase, high blood D-dimer, high blood lactate dehydrogenase (LDH), high blood C-reactive protein (CRP), decrease in lymphocyte count, high blood aspartate aminotransferase (AST), decrease in blood albumin, high blood interleukin-6 (IL-6), high blood neutrophil count, high blood B-type natriuretic peptide (BNP), high blood urea nitrogen (BUN), high blood creatine kinase (CK), high blood bilirubin and high erythrocyte sedimentation rate (ESR)), radiological factors (consolidative infiltrate and pleural effusion) and high SOFA score (sequential organ failure assessment score).ĬOVID-19 is an infectious disease caused by the SARS-CoV-2 coronavirus. The same principles GRADE proposed for bodies of evidence addressing treatment and overall prognosis work well in assessing individual prognostic factors, both in noncontextualized and contextualized settings.Ĭertainty in evidence GRADE Guideline Prognosis Prognostic factor Subgroup Systematic review.Ĭopyright © 2020 Elsevier Inc. One should determine if their ratings do not consider (noncontextualized) or consider (contextualized) the clinical context as this will may result in variable judgments on certainty of the evidence. The five domains of GRADE for rating down certainty in the evidence, that is, risk of bias, imprecision, inconsistency, indirectness, and publication bias, as well as the domains for rating up, also apply to estimates of associations between prognostic factors and outcomes. We developed our guidance through an iterative process that involved review of published systematic reviews and meta-analyses of prognostic factors, consultation with members, feedback, presentation, and discussion at the GRADE Working Group meetings.įor questions of prognosis, a body of observational evidence (potentially including patients enrolled in randomized controlled trials) begins as high certainty in the evidence. The objective of this study was to provide guidance on the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to determine certainty in estimates of association between prognostic factors and future outcomes. 11 Department of Guideline Development, Dutch College of General Practitioners, Utrecth, The Netherlands.10 School of Health and Population Sciences, University of Birmingham, Birmingham, UK.9 Department of Medicine, McMaster University, Ontario, Canada.8 Faculty of Health and Medical Sciences, Joanna Briggs Institute, The University of Adelaide, Adelaide, Australia.Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador. 7 Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health, Madrid, Spain Centro de investigación en Salud Pública y Epidemiología Clínica.6 Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.5 Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, USA.
1 Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada Ted Rogers Center for Heart Research, Toronto General Hospital, Ontario, Canada.
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