Chunyan Wang,1,* Xiaolei Zheng,2,* Shaojie Bi,3 Mingju Shao,4 Zhaohong Xie,2 Ning Wei,5 Qingbo Zhou,1,2,6 Shiqing Feng7– 9 

1Department of Geriatrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People’s Republic of China; 2Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People’s Republic of China; 3Department of Cardiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People’s Republic of China; 4Department of Emergency, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People’s Republic of China; 5Department of Information Center, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People’s Republic of China; 6School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People’s Republic of China; 7Department of Orthopedics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People’s Republic of China; 8Orthopedic Research Center of Shandong University and Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People’s Republic of China; 9International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Qingbo Zhou, Email qingbozhou2021@163.com

Background: The Omicron subvariants of SARS-CoV-2 spread rapidly since 2021. Following China’s relaxation of containment measures in December 2022, a surge in COVID-19 cases poses a public health threat. Early identification of elderly COVID-19 patients at death risk is crucial for optimizing treatment and resource use.
Objective: To develop a clinical score for predicting death risk in elderly COVID-19 patients at hospital admission, based on a cohort from the Second Hospital of Shandong University.
Methods: We established a retrospective cohort of hospitalized COVID-19 patients from November 1, 2022, to March 31, 2023. Cox regression identified prognostic factors, leading to the development of a nomogram-based prediction model and a clinical risk score. Patients were classified into low- and high-risk groups using optimal segmentation thresholds, with survival curves generated by the Kaplan–Meier method. An online risk calculator was developed to facilitate real-time risk assessment in clinical settings.
Results: The cohort included 1413 hospitalized COVID-19 patients. Elderly patients (≥ 60 years, N = 971) had a high mortality rate of 18.13%. Four independent predictors of mortality were identified: age (HR = 1.07), serum albumin (HR = 0.88), serum potassium (HR = 0.35), and serum sodium (HR = 0.91). The developed risk score demonstrated strong predictive performance and effectively stratified patients into risk categories.
Conclusion: We developed a validated clinical risk score integrating age, serum albumin, potassium, and sodium levels to predict mortality in hospitalized elderly COVID-19 patients. This scoring system enables early risk stratification, assisting clinicians in decision-making and optimizing patient management.

Keywords: hospitalized elder patients with COVID-19, clinical risk score, death risk, albumin, electrolyte levels