1
|
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]
Collapse
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
| | | |
Collapse
|
2
|
Marcolino MS, Ziegelmann PK, Souza-Silva MVR, Nascimento IJB, Oliveira LM, Monteiro LS, Sales TLS, Ruschel KB, Martins KPMP, Etges APBS, Molina I, Polanczyk CA. Clinical characteristics and outcomes of patients hospitalized with COVID-19 in Brazil: Results from the Brazilian COVID-19 registry. Int J Infect Dis 2021; 107:300-310. [PMID: 33444752 PMCID: PMC7801187 DOI: 10.1016/j.ijid.2021.01.019] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To describe the clinical characteristics, laboratory results, imaging findings, and in-hospital outcomes of COVID-19 patients admitted to Brazilian hospitals. METHODS A cohort study of laboratory-confirmed COVID-19 patients who were hospitalized from March 2020 to September 2020 in 25 hospitals. Data were collected from medical records using Research Electronic Data Capture (REDCap) tools. A multivariate Poisson regression model was used to assess the risk factors for in-hospital mortality. RESULTS For a total of 2,054 patients (52.6% male; median age of 58 years), the in-hospital mortality was 22.0%; this rose to 47.6% for those treated in the intensive care unit (ICU). Hypertension (52.9%), diabetes (29.2%), and obesity (17.2%) were the most prevalent comorbidities. Overall, 32.5% required invasive mechanical ventilation, and 12.1% required kidney replacement therapy. Septic shock was observed in 15.0%, nosocomial infection in 13.1%, thromboembolism in 4.1%, and acute heart failure in 3.6%. Age >= 65 years, chronic kidney disease, hypertension, C-reactive protein ≥ 100mg/dL, platelet count < 100×109/L, oxygen saturation < 90%, the need for supplemental oxygen, and invasive mechanical ventilation at admission were independently associated with a higher risk of in-hospital mortality. The overall use of antimicrobials was 87.9%. CONCLUSIONS This study reveals the characteristics and in-hospital outcomes of hospitalized patients with confirmed COVID-19 in Brazil. Certain easily assessed parameters at hospital admission were independently associated with a higher risk of death. The high frequency of antibiotic use points to an over-use of antimicrobials in COVID-19 patients.
Collapse
Affiliation(s)
- Milena S Marcolino
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190 sala 246, Belo Horizonte, Brazil.
| | - Patricia K Ziegelmann
- Universidade Federal do Rio Grande do Sul and Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359. Prédio 21, Sala 507, Porto Alegre, Brazil.
| | - Maira V R Souza-Silva
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190 sala 246, Belo Horizonte, Brazil.
| | - I J B Nascimento
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190 sala 246, Belo Horizonte, Brazil.
| | - Luana M Oliveira
- Center for Research and Graduate Studies in Business Administration, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil.
| | - Luanna S Monteiro
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190 sala 246, Belo Horizonte, Brazil.
| | - Thaís L S Sales
- Universidade Federal de São João del-Rey, R. Sebastião Gonçalves Coelho, 400, Divinópolis, Brazil.
| | - Karen B Ruschel
- Universidade Federal do Rio Grande do Sul and Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359. Prédio 21, Sala 507, Porto Alegre, Brazil.
| | - Karina P M P Martins
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190 sala 246, Belo Horizonte, Brazil.
| | - Ana Paula B S Etges
- Universidade Federal do Rio Grande do Sul and Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359. Prédio 21, Sala 507, Porto Alegre, Brazil.
| | - Israel Molina
- Vall d'Hebron University Hospital, PROSICS Barcelona, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain; Instituto René Rachou-FIOCRUZ Minas, Av. Augusto de Lima, 1715, Belo Horizonte, Brazil.
| | - Carisi A Polanczyk
- Universidade Federal do Rio Grande do Sul and Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359. Prédio 21, Sala 507, Porto Alegre, Brazil.
| |
Collapse
|