1
|
Bagnato G, La Rosa D, Ioppolo C, De Gaetano A, Chiappalone M, Zirilli N, Viapiana V, Tringali MC, Tomeo S, Aragona CO, Napoli F, Lillo S, Irrera N, Roberts WN, Imbalzano E, Micari A, Ventura Spagnolo E, Squadrito G, Gangemi S, Versace AG. The COVID-19 Assessment for Survival at Admission (CASA) Index: A 12 Months Observational Study. Front Med (Lausanne) 2021; 8:719976. [PMID: 34660631 PMCID: PMC8514624 DOI: 10.3389/fmed.2021.719976] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/02/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: Coronavirus disease 2019 (COVID-19) is a disease with a high rate of progression to critical illness. However, the stratification of patients at risk of mortality is not well defined. In this study, we aimed to define a mortality risk index to allocate patients to the appropriate intensity of care. Methods: This is a 12 months observational longitudinal study designed to develop and validate a pragmatic mortality risk score to stratify COVID-19 patients aged ≥18 years and admitted to hospital between March 2020 and March 2021. Main outcome was in-hospital mortality. Results: 244 patients were included in the study (mortality rate 29.9%). The Covid-19 Assessment for Survival at Admission (CASA) index included seven variables readily available at admission: respiratory rate, troponin, albumin, CKD-EPI, white blood cell count, D-dimer, Pa02/Fi02. The CASA index showed high discrimination for mortality with an AUC of 0.91 (sensitivity 98.6%; specificity 69%) and a better performance compared to SOFA (AUC = 0.76), age (AUC = 0.76) and 4C mortality (AUC = 0.82). The cut-off identified (11.994) for CASA index showed a negative predictive value of 99.16% and a positive predictive value of 57.58%. Conclusions: A quick and readily available index has been identified to help clinicians stratify COVID-19 patients according to the appropriate intensity of care and minimize hospital admission to patients at high risk of mortality.
Collapse
Affiliation(s)
- Gianluca Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Daniela La Rosa
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmelo Ioppolo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alberta De Gaetano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marianna Chiappalone
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Natalia Zirilli
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Valeria Viapiana
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Simona Tomeo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Francesca Napoli
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Sara Lillo
- BIOMORF Department, University of Messina, Messina, Italy
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Micari
- BIOMORF Department, University of Messina, Messina, Italy
| | - Elvira Ventura Spagnolo
- Department for Health Promotion and Mother-Child Care, University of Palermo, Palermo, Italy
| | - Giovanni Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | |
Collapse
|