Mortality Prediction of COVID-19 in Hospitalized Patients Using the 2020 Diagnosis Procedure Combination Administrative Database of Japan

• Published in: Internal Medicine Vol. 62; no. 2; pp. 201 - 213
• Main Authors: Nojiri, Shuko, Irie, Yoshiki, Kanamori, Rie, Naito, Toshio, Nishizaki, Yuji
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.01.2023; Japan Science and Technology Agency
• Subjects: Analgesics; Anesthesia; Angiotensin; Cerebrovascular diseases; Clinical trials; Coronaviruses; COVID-19; COVID-19 Testing; Decision making; Diabetes; Diabetes Mellitus; Diagnosis; Disease; DPC database; Drugs; Gastrointestinal diseases; Hospitalization; Humans; Internal medicine; Japan; Japan - epidemiology; Kidney diseases; machine learning; Male; Middle Aged; Mortality; Movement disorders; Neurodegenerative diseases; Original; Parkinson's disease; Patients; Pneumonia; Population density; Prediction models; Renin; Resource utilization; Respiratory tract diseases; Retrospective Studies; Risk factors; Vascular diseases; Japan; COVID-19; DPC database; machine learning; Japan
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.0086-22

Objectives Numerous people have died from coronavirus disease 2019 (COVID-19) infection. Identifying crucial predictive biomarkers of disease mortality is critical to support decision-making and logistic planning in healthcare systems. This study investigated the association between mortality and medical factors and prescription records in 2020 in Japan, where COVID-19 prevalence and mortality remain relatively low. Methods This retrospective cohort study analyzed anonymous administrative data from the Diagnosis Procedure Combination (DPC) database in Japan. Results A total of 22,795 patients were treated in DPC hospitals in 2020 in Japan, and of these, 5,980 patients over 50 years old were hospitalized, with 299 (5.0%) dying. There were 2,399 severe patients among 11,440 total hospitalized patients (all ages). The results of a logistic model analysis revealed that an older age, male sex, Parkinson's disease, cerebrovascular diseases, and chronic kidney diseases were risk factors for mortality. A machine learning analysis identified an older age, male sex (mortality), pneumonia, drugs for acid-related disorders, analgesics, anesthesia, upper respiratory tract disease, drugs for functional gastrointestinal disorders, drugs for obstructive airway diseases, topical products for joint and muscular pain, diabetes, lipid-modifying agents, calcium channel blockers, drugs for diabetes, and agents acting on the renin-angiotensin system as risk factors for a severe status. Conclusions This COVID-19 mortality risk tool is a well-calibrated and accurate model for predicting mortality risk among hospitalized patients with COVID-19 in Japan, which is characterized by a relatively low COVID-19 prevalence, aging society, and high population density. This COVID-19 mortality prediction model can assist in resource utilization and patient and caregiver education and be useful as a risk stratification instrument for future research trials.