ABC2-SPH risk score for in-hospital mortality in COVID-19 patients: development, external validation and comparison with other available scores

• DOI: 10.1016/j.ijid.2021.07.049
• Publication Date: 2021-07-24T05:33:50Z
• Authors: Milena S. Marcolino; Magda C. Pires; Lucas Emanuel F. ...; Rafael T. Silva; Luana M. Oliveira; Rafael L.R. Carvalho; Rodolfo Lucas S. ...; Adrián Sánchez-Mo...; Berta Raventós; Fernando Anschau; José Miguel Chatkin; Matheus C.A. Nogu...; Milton H. Guimarã...; Giovanna G. Vietta; Helena Duani; Daniela Ponce; Patricia K. Ziege...; Luís C. Castro; Karen B. Ruschel; Christiane C.R. C...; Saionara C. Franc...; Maiara A. Floriani; Guilherme F. Nasc...; Bárbara L. Farace; Luanna S. Monteiro; Maira V.R. Souza-...; Thais L.S. Sales; Karina Paula M.P....; Israel J. Borges ...; Tatiani O. Feregu...; Daniel T.M.O. Fer...; Fernando A. Botoni; Ana Paula B.S. Etges; Alexandre V. Schw...; Amanda O. Maurílio; Ana Luiza B.A. Sc...; André P. Weber; André S.M. Costa; Andressa B. Glaeser; Angélica Aparecid...; Angelinda R. Bhering; Bruno Mateus de C...; Carla Thais C.A. ...; Carolina M. Ramos; Caroline D. Gomes; Cíntia A. de Carv...; Daniel V. Silveira; Edilson Cezar; Elayne C. Pereira; Emanuele Marianne...; Felipe B. Vallt; Fernanda B. Lucas; Fernando G. Aranha; Frederico Bartolazzi; Gabriela P. Crestani; Gisele A.N. Bastos; Glícia Cristina d...; Helena Carolina Noal; Heloisa R. Vianna; Henrique C. Guima...; Isabela M. Gomes; Israel Molina; Joanna d'Arc L. B...; Joice C. de Alvar...; Júlia D.S.S. Guim...; Júlia D.P. de Morais; Juliana M. Rugolo; Karen Cristina J....; Kauane Aline M. d...; Leonardo S. de Ol...; Lílian S. Pinheiro; Liliane S. Pacheco; Lucas de D. Sousa; Luciana S.F. Couto; Luciane Kopittke; Luis Cesar S. de ...; Luisa Elem A. Santos; Máderson A.S. Cabral; Maíra D. Souza; Marcela G.T. Tofani; Marcelo Carneiro; Maria Angélica P....; Maria Aparecida C...; Maria Clara P.B. ...; Mariana F. Godoy; Marilia M.A. Cardoso; Meire P. Figueiredo; Natália C.S. Sampaio; Natália L. Rangel; Natália T. Crespo; Neimy R. de Oliveira; Pedro L. Assaf; Petrônio José de ...; Rafaela S.C. Almeida; Raphael C. Martins; Raquel Lutkmeier; Reginaldo Apareci...; Renan G. Finger; Ricardo B. Cardoso; Roberta Pozza; Roberta X. Campos; Rochele M. Menezes; Roger M. de Abreu; Rufino de F. Silva; Silvana M.M. Guim...; Silvia F. Araújo; Susany Anastácia ...; Talita F. Oliveira; Tatiana Kurtz; Thainara C. de Ol...; Thaíza Simônia M....; Thulio Henrique O...; Veridiana B. dos ...; Virginia Mara R. ...; Vitor Augusto L. ...; Yuri C. Ramires; Eric Boersma; Carisi A. Polanczyk
• Keywords: COVID-19 (Malaltia) - Mortalitat; Infectious and parasitic diseases; RC109-216; Article; 03 medical and health sciences; 0302 clinical medicine; SDG 3 - Good Health and Well-being; Risk Factors; Mortalitat - Estadístiques; :Other subheadings::Other subheadings::Other subheadings::/mortality [Other subheadings]; :virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES]; :técnicas de investigación::métodos epidemiológicos::recopilación de datos::estadísticas vitales::mortalidad::mortalidad hospitalaria [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS]; Humans; Hospital Mortality; Mortality; :Diagnosis::Prognosis [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT]; :Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality::Hospital Mortality [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT]; :diagnóstico::pronóstico [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS]; Aged; Retrospective Studies; Hospitalizations; COVID-19 (Malaltia) - Prognosi; :Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad [Otros calificadores]; SARS-CoV-2; Score; COVID-19; :Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES]; Middle Aged; Prognosis; 3. Good health; Hospitalization; Risk factors

The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones.Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March-July, 2020. The model was validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients.Median (25-75th percentile) age of the model-derivation cohort was 60 (48-72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the 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 0.829-0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833-0.885]) and Spanish (0.894 [95% CI 0.870-0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/).An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19.