Int J Infect Dis . ABC 2-SPH risk score for in-hospital mortality in COVID-19 patients: development, external validation and comparison with other available scores

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Int J Infect Dis


. 2021 Jul 23;S1201-9712(21)00605-6.
doi: 10.1016/j.ijid.2021.07.049. Online ahead of print.
ABC ₂-SPH risk score for in-hospital mortality in COVID-19 patients: development, external validation and comparison with other available scores


Milena S Marcolino ¹ , Magda C Pires ² , Lucas Emanuel F Ramos ³ , Rafael T Silva ⁴ , Luana M Oliveira ⁵ , Rafael L R Carvalho ⁶ , Rodolfo Lucas S Mourato ⁷ , Adrián Sánchez-Montalvá ⁸ , Berta Raventós ⁹ , Fernando Anschau ¹⁰ , José Miguel Chatkin ¹¹ , Matheus C A Nogueira ¹² , Milton H Guimarães Júnior ¹³ , Giovanna G Vietta ¹⁴ , Helena Duani ¹⁵ , Daniela Ponce ¹⁶ , Patricia K Ziegelmann ¹⁷ , Luís C Castro ¹⁸ , Karen B Ruschel ¹⁹ , Christiane C R Cimini ²⁰ , Saionara C Francisco ²¹ , Maiara A Floriani ²² , Guilherme F Nascimento ²³ , Bárbara L Farace ²⁴ , Luanna S Monteiro ²⁵ , Maira V R Souza-Silva ²⁶ , Thais L S Sales ²⁷ , Karina Paula M P Martins ²⁸ , Israel J Borges do Nascimento ²⁹ , Tatiani O Fereguetti ³⁰ , Daniel T M O Ferrara ³¹ , Fernando A Botoni ³² , Ana Paula B S Etges ³³ , Eric Boersma ³⁴ , Carisi A Polanczyk ³⁵ , Alexandre V Schwarzbold ³⁶ , Amanda O Maurílio ³⁷ , Ana Luiza B A Scotton ³⁸ , André P Weber ³⁹ , André S M Costa ⁴⁰ , Andressa B Glaeser ⁴¹ , Angélica Aparecida C Madureira ⁴² , Angelinda R Bhering ⁴³ , Bruno Mateus de Castro ⁴⁴ , Carla Thais C A da Silva ⁴⁵ , Carolina M Ramos ⁴⁶ , Caroline D Gomes ⁴⁷ , Cíntia A de Carvalho ⁴⁸ , Daniel V Silveira ⁴⁹ , Edilson Cezar ⁵⁰ , Elayne C Pereira ⁵¹ , Emanuele Marianne S Kroger ⁵² , Felipe B Vallt ⁵³ , Fernanda B Lucas ⁵⁴ , Fernando G Aranha ⁵⁵ , Frederico Bartolazzi ⁵⁶ , Gabriela P Crestani ⁵⁷ , Gisele A N Bastos ⁵⁸ , Glícia Cristina de C Madeira ⁵⁹ , Helena Carolina Noal ⁶⁰ , Heloisa R Vianna ⁶¹ , Henrique C Guimarães ⁶² , Isabela M Gomes ⁶³ , Israel M Romero ⁶⁴ , Joanna D L Batista ⁶⁵ , Joice C de Alvarenga ⁶⁶ , Júlia D S S Guimarães ⁶⁷ , Júlia D P de Morais ⁶⁸ , Juliana M Rugolo ⁶⁹ , Karen Cristina J R Pontes ⁷⁰ , Kauane Aline M Dos Santos ⁷¹ , Leonardo S de Oliveira ⁷² , Lílian S Pinheiro ⁷³ , Liliane S Pacheco ⁷⁴ , Lucas de D Sousa ⁷⁵ , Luciana S F Couto ⁷⁶ , Luciane Kopittke ⁷⁷ , Luis Cesar S de Moura ⁷⁸ , Luisa Elem A Santos ⁷⁹ , Máderson A S Cabral ⁸⁰ , Maíra D Souza ⁸¹ , Marcela G T Tofani ⁸² , Marcelo Carneiro ⁸³ , Maria Angélica P Ferreira ⁸⁴ , Maria Aparecida C Bicalho ⁸⁵ , Maria Clara P B Lima ⁸⁶ , Mariana F Godoy ⁸⁷ , Marilia M A Cardoso ⁸⁸ , Meire P Figueiredo ⁸⁹ , Natália C S Sampaio ⁹⁰ , Natália L Rangel ⁹¹ , Natália T Crespo ⁹² , Neimy R de Oliveira ⁹³ , Pedro L Assaf ⁹⁴ , Petrônio José de L Martelli ⁹⁵ , Rafaela S C Almeida ⁹⁶ , Raphael C Martins ⁹⁷ , Raquel Lutkmeier ⁹⁸ , Reginaldo Aparecido Valacio ⁹⁹ , Renan G Finger ¹⁰⁰ , Ricardo B Cardoso ¹⁰¹ , Roberta Pozza ¹⁰² , Roberta X Campos ¹⁰³ , Rochele M Menezes ¹⁰⁴ , Roger M de Abreu ¹⁰⁵ , Rufino de F Silva ¹⁰⁶ , Silvana M M Guimarães ¹⁰⁷ , Silvia F Araújo ¹⁰⁸ , Susany Anastácia Pereira ¹⁰⁹ , Talita F Oliveira ¹¹⁰ , Tatiana Kurtz ¹¹¹ , Thainara C de Oliveira ¹¹² , Thaíza Simônia M A Araújo ¹¹³ , Thulio Henrique O Diniz ¹¹⁴ , Veridiana B Dos Santos ¹¹⁵ , Virginia Mara R Gomes ¹¹⁶ , Vitor Augusto L do Vale ¹¹⁷ , Yuri C Ramires ¹¹⁸



Affiliations

• PMID: 34311100
• DOI: 10.1016/j.ijid.2021.07.049

Abstract

Objectives: The majority of available scores to assess mortality risk of coronavirus disease 19 (COVID-19) patients in the emergency department have high risk of bias. Therefore, our aim was 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.
Methods: 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.
Results: Median (25th-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 to 0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833 to 0.885]) and Spanish (0.894 [95% CI 0.870 to 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/).
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.

Keywords: COVID-19; SARS-CoV-2; hospitalizations; mortality; prognosis; risk factors; score.