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Development and validation of the ABC2-SPH risk score for in-hospital mortality in COVID-19 patients
European Heart Journal ; 42(SUPPL 1):3129, 2021.
Article in English | EMBASE | ID: covidwho-1554360
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.
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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Prognostic study Language: English Journal: European Heart Journal Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Prognostic study Language: English Journal: European Heart Journal Year: 2021 Document Type: Article