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Marcolino M, Pires MC, Ramos LEF, Silva RT, Oliveira LM, Carvalho RLR, Monteiro LS, Souza-Silva MVR, Sales TLS, Martins KPMP, Borges Do Nascimento IJ, Sanchez-Montalva A, Raventos B, Boersma E, Polanczyk CA. Development and validation of the ABC2-SPH risk score for in-hospital mortality in COVID-19 patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Fast and efficient assessment of prognosis of coronavirus disease 19 (COVID-19) is needed to optimize the allocation of health care and human resources, to empower early identification and intervention of patients at higher risk of poor outcome. A proper assessment tool may guide decision making, to develop an appropriate plan of care for each patient. Although different scores have been proposed, the majority of them are limited due to high risk of bias, and there is a lack of reliable prognostic prediction models.
Purpose
To develop and validate an easy applicable rapid scoring system that employs routinely available clinical and laboratory data at hospital presentation, to predict in-hospital mortality in patients with COVID-19, able to discriminate high vs non-high risk patients. Additionally, we aimed to compare this score with other existing ones.
Method
Cohort study, conducted in 36 Brazilian hospitals in 17 cities. Consecutive symptomatic patients (≥18 years old) with laboratory confirmed COVID-19 admitted to participating hospitals. Primary outcome was in-hospital mortality. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients that were admitted between March-July, 2020. The model was then validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients.
Results
Median (25th-75th percentile) age of the model-derivation cohort was 60 (48–72) years, 53.8% were men, in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. From 20 potential predictors, seven significant variables were included in the in-hospital mortality risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829 to 0.859), which was confirmed in the Brazilian (0.859) and Spanish (0.899) validation cohorts. Our ABC2-SPH score showed good calibration in both Brazilian cohorts, but, in the Spanish cohort, mortality was somewhat underestimated in patients with very high (>25%) risk. The ABC2-SPH score is implemented in a freely available online risk calculator.
Conclusions
We designed and validated an easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation, for early stratification for in-hospital mortality risk of patients with COVID-19.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Minas Gerais State Agency for Research and Development (Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG) [grant number APQ-00208-20], National Institute of Science and Technology for Health Technology Assessment (Instituto de Avaliação de Tecnologias em Saúde – IATS)/ National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnolόgico - CNPq) [grant number 465518/2014-1]
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Affiliation(s)
- M Marcolino
- Medical School, Universidade Federal de Minas Gerais and Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| | - M C Pires
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - L E F Ramos
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - R T Silva
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - L M Oliveira
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - R L R Carvalho
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - L S Monteiro
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - M V R Souza-Silva
- Medical School, Universidade Federal de Minas Gerais and Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| | - T L S Sales
- Universidade Federal de Sao Joao del-Rei, Divinopolis, Brazil
| | - K P M P Martins
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - A Sanchez-Montalva
- University Hospital Vall d'Hebron, Infectious Diseases Department, Barcelona, Spain
| | - B Raventos
- University Hospital Vall d'Hebron, Infectious Diseases Department, Barcelona, Spain
| | - E Boersma
- Erasmus University Medical Centre, Department of Cardiology, Rotterdam, Netherlands (The)
| | - C A Polanczyk
- Universidade Federal do Rio Grande do Sul, Internal Medicine Department, Belo Horizonte, Brazil
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Marcolino M, Molina I, Pires MC, Ramos LEF, Silva RT, Guimaraes Junior MH, Carvalho RLR, Barros ALRM, Ribeiro AL, Duani H, Anschau F, Botoni FA, Oliveira NR, Polanczyk CA, Nunes MCP. Clinical characteristics and in-hospital outcomes of patients coinfected with Chagas disease and SARS-CoV-2. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Underlying comorbidities have been widely associated with a worse prognosis for COVID-19 patients, since viral infections could act as triggers for worsening of chronic diseases.
Although Chagas disease (CD) is endemic in Latin America, it has been recognized that the disease is now a worldwide concern. Information on the interplay between COVID-19 and CDis lacking.
Purpose
To assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients.
Methods
Patients with COVID-19 diagnosis were selected from the Brazilian COVID-19 Registry, a prospective multicenter cohort, from March to September, 2020. CD diagnosis was based on hospital record at the time of admission. Study data were collected by trained hospital staff using Research Electronic Data Capture (REDCap) tools. Genetic matching for sex, age, hypertension, DM and hospital was performed in a 4:1 ratio.
Results
Of the 7,018 patients who had confirmed infection with SARS-CoV-2 in the registry, 31 patients with CD and 124 matched controls were included. Overall, the median age was 72 (64.-80) years-old and 44.5% were male. At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p<0.05 for both). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). Seventy-two (46.5%) patients required admission to the intensive care unit. In-hospital management, outcomes and complications were similar between the groups (Table 1).
Conclusions
In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported in part by Minas Gerais State Agency for Research and Development (Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG) [grant number APQ-00208-20], National Institute of Science and Technology for Health Technology Assessment (Instituto de Avaliação de Tecnologias em Saúde – IATS)/ National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnolόgico - CNPq) [grant number 465518/2014-1], Table 1. Clinical outcomes
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Affiliation(s)
- M Marcolino
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - I Molina
- University Hospital Vall d'Hebron, Infectious Diseases Department, Barcelona, Spain
| | - M C Pires
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - L E F Ramos
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - R T Silva
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - R L R Carvalho
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - A L R M Barros
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - A L Ribeiro
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - H Duani
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - F Anschau
- Hospital Nossa Senhora da Conceicao (HNSC), Porto Alegre, Brazil
| | - F A Botoni
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - N R Oliveira
- Hospital Eduardo de Menezes, Belo Horizonte, Brazil
| | - C A Polanczyk
- Universidade Federal do Rio Grande do Sul, Belo Horizonte, Brazil
| | - M C P Nunes
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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