Evaluation of Modified ATRIA Risk Score in Predicting Mortality in Hospitalized Patients With COVID-19.

BACKGROUND: As the Modified Anticoagulation and Risk Factors in Atrial Fibrillation Risk Score (M-ATRIA-RS) encompasses prognostic risk factors of novel coronavirus-2019 (COVID-19), it may be used to predict in-hospital mortality. We aimed to investigate whether M-ATRIA-RS was an independent predictor of mortality in patients hospitalized for COVID-19 and compare its discrimination capability with CHADS, CHA2DS2-VASc, and modified CHA2DS2-VASc (mCHA2DS2-VASc)-RS. METHODS: A total of 1,001 patients were retrospectively analyzed and classified into three groups based on M-ATRIA-RS, designed by changing sex criteria of ATRIA-RS from female to male: Group 1 for points 0-1 (n = 448), Group 2 for points 2-4 (n = 268), and Group 3 for points ≥5 (n = 285). Clinical outcomes were defined as in-hospital mortality, need for high-flow oxygen and/or intubation, and admission to intensive care unit. RESULTS: As the M-ATRIA-RS increased, adverse clinical outcomes significantly increased (Group 1, 6.5%; Group 2, 15.3%; Group 3, 34.4%; p <0.001 mortality for in-hospital). Multivariate logistic regression analysis showed that M-ATRIA-RS, malignancy, troponin increase, and lactate dehydrogenase were independent predictors of in-hospital mortality (p<0.001, per scale possibility rate for ATRIA-RS 1.2). In receiver operating characteristic (ROC) analysis, the discriminative ability of M-ATRIA-RS was superior to mCHA2DS2-VASc-RS and ATRIA-RS, but similar to that Charlson Comorbidity Index (CCI) score (AUCM-ATRIAvs AUCATRIA Z-test=3.14 p = 0.002, AUCM-ATRIAvs. AUCmCHA2DS2-VASc Z-test=2.14, p = 0.03; AUCM-ATRIAvs. AUCCCI Z-test=1.46 p = 0.14). CONCLUSIONS: M-ATRIA-RS is useful to predict in-hospital mortality among patients hospitalized with COVID-19. In addition, it is superior to the mCHA2DS2-VASc-RS in predicting mortality in patients with COVID-19 and is more easily calculable than the CCI score.

The Association between Chronic Use of Renin-Angiotensin-Aldosterone System Blockers and in-Hospital Adverse Events among COVID-19 Patients with Hypertension.

OBJECTIVES: The effects of chronic renin-angiotensin-aldosterone system (RAAS) blockers usage on adverse outcomes and disease severity remain uncertain in COVID-19 patients with hypertension. In this study, we aimed to determine the relationship between chronic use of RAAS inhibitors and in-hospital adverse events among hypertensive patients hospitalized with COVID-19. METHODS: In this retrospective single-center study, we enrolled 349 consecutive hypertensive patients diagnosed with COVID-19 infection. All patients were chronically on angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin II receptor blockers (ARB) or other antihypertensive therapies before hospital admission. Adverse clinical events were defined as in-hospital mortality, admission to intensive care unit, need for high-flow oxygen and intubation. RESULTS: Patients were categorized into two groups according to the type of antihypertensive therapy. (ACEI/ARBs users, N=201; ACEI/ARB nonusers, N=148) There was no statistically significant difference between ACEI/ARBs users and ACEI/ARBs nonusers concerning adverse clinical events, such as in-hospital mortality (29 (14.4%) vs. 20 (13.5%), p=0.81), ICU admission (45(22.4%) vs. 27 (18.2%), p=0.34), need for high-flow oxygen (97 (48.3%) vs. 68 (45.9%), p=0.67) and need for intubation (32(15.9%) vs. 23(15.5%), p=0.92), respectively. Also, the severity of infection did not differ among groups. The logistic regression multivariate analysis showed that age, neutrophil-lymphocyte ratio, procalcitonin and ferritin levels were independent predictors of in-hospital mortality. CONCLUSION: Our results suggest that chronic use of ACEI/ARBs did not increase in-hospital adverse outcomes of hypertensive patients hospitalized with COVID-19. Although the recent data are contradictory, chronic ACEI/ARB therapy is not recommended to be discontinued in hypertensive patients during their hospitalization for COVID-19.

The relation between left ventricular global longitudinal strain and troponin levels in patients hospitalized with COVID-19 pneumonia.

Left ventricular global longitudinal strain (LVGLS) from two-dimensional speckle-tracking echocardiography (2D-STE) provides a more accurate estimation of subclinical myocardial dysfunction. In patients with COVID-19, elevated high sensitive troponin (hs-TnI) levels are frequent independent from the underlying cardiovascular disease. However, the relationship between high troponin levels and LVGLS in such patients remains unknown. We aimed to investigate the relation between troponin levels and LVGLS values in patients with COVID-19. A total of thirty-eight patients diagnosed with COVID-19 pneumonia who underwent echocardiography examination within the first week of hospital admission were enrolled in our study. Patients were divided into two groups according to their hs-TnI levels. Conventional left venticular (LV) function parameters, including ejection fraction, LV diastolic and systolic volumes were obtained and LVGLS was determined using 2D-STE. Frequency of hypertension, diabetes mellitus and current smoking were similar among groups. Compared with the patients in the negative troponin group, those in the positive troponin group were more likely to have a higher age; higher levels of D-dimer, C-reactive protein and ferritin; higher need for high-flow oxygen, invasive mechanical ventilation therapy or both; and a higher number of intensive care unit admissions. There was no statistically significant difference in LVGLS and ejection fraction values between the two groups.(- 18.5 ± 2.9, - 19.8 ± 2.8, p = 0.19; 55.2 ± 9.9, 59.5 ± 5.9, p = 0.11 respectively). Despite troponin increase is highly related to in-hospital adverse events; no relevance was found between troponin increase and LVGLS values of COVID-19 patients.

Assessment of the Modified CHA2DS2VASc Risk Score in Predicting Mortality in Patients Hospitalized With COVID-19.

Since the modified CHA2DS2VASC (M-CHA2DS2VASc) risk score includes the prognostic risk factors for COVID-19; we assumed that it might predict in-hospital mortality and identify high-risk patients at an earlier stage compared with troponin increase and neutrophil-lymphocyte ratio (NLR). We aimed to investigate whether M-CHA2DS2VASC RS is an independent predictor of mortality in patients hospitalized with COVID-19 and to compare its discriminative ability with troponin increase and NLR in terms of predicting mortality. A total of 694 patients were retrospectively analyzed and divided into 3 groups according to M-CHA2DS2VASC RS which was simply created by changing gender criteria of the CHA2DS2VASC RS from female to male (Group 1, score 0-1 (n = 289); group 2, score 2-3 (n = 231) and group 3, score ≥4 (n = 174)). Adverse clinical events were defined as in-hospital mortality, admission to intensive care unit, need for high-flow oxygen and/or intubation. As the M-CHA2DS2VASC RS increased, adverse clinical outcomes were also significantly increased (Group 1, 3.8%; group 2, 12.6%; group 3, 20.8%; p <0.001 for in-hospital mortality). The multivariate logistic regression analysis showed that M-CHA2DS2VASC RS, troponin increase and neutrophil-lymphocyte ratio were independent predictors of in-hospital mortality (p = 0.005, odds ratio 1.29 per scale for M-CHA2DS2VASC RS). In receiver operating characteristic analysis, comparative discriminative ability of M-CHA2DS2VASC RS was superior to CHA2DS2VASC RS score. Area under the curve (AUC) values for in-hospital mortality was 0.70 and 0.64, respectively. (AUCM-CHA2DS2-VASc vs. AUCCHA2DS2-VASc z test = 3.56, p 0.0004) In conclusion, admission M-CHA2DS2VASc RS may be a useful tool to predict in-hospital mortality in patients with COVID-19.