Diagnostic Value of the COVID-GRAM and 4C Mortality Score in Predicting Critical Events Among ESRD Patients With COVID-19

ABSTRACT

Background: Around 800 ESRD patients from March 2021 to July 2021 were affected by COVID-19 in a tertiary specialized hospital in the Philippines, with a case fatality rate of 2.3%. These subset of patients have one of the highest morbidity and mortality among others. That is why numerous tools such as the COVID GRAM and 4C Mortality Score were formulated to predict the critical events in COVID-19 patient and may hopefully be useful for ESRD patients as well. Method(s) This is a retrospective cohort design to determine the diagnostic value of COVID GRAM and Mortality 4C score in predicting critical events. Participants were end stage renal disease (ESRD) patients infected with COVID19 seen at the National Kidney and Transplant Institute from March 2020 to July 2021. Chart review was done from August 2021 to October 2021. Inclusion Criteria Age >=19 years old Admitted patients for at least 24hrs COVID-19 confirmed via RT PCR or GeneXpert with nasopharyngeal or oropharyngeal swab, provided that Testing performed in an accredited institution ESRD Filipino patients already on RRT or for RRT initiation Exclusion Criteria Kidney transplant patients Acute kidney injury needing renal replacement therapy Incomplete data on 4C mortality and COVID GRAM Results: This study included a total of 97 patients (41 in the critical group, 56 in non-critical group). Both COVID GRAM and 4C mortality score showed high levels of discriminative ability, accuracy, sensitivity, specificity. The discriminative ability or AUC of both COVID GRAM and 4C Mortality Score were at 0.93 and 0.95, respectively. Overall accuracy was at 93.81% and 96.91%. Conclusion(s) Even with the advent of vaccination, COVID 19 remains to be a leading cause of morbidity and mortality in our country and has cost the Philippine government $30.72B. Therefore, proper allocation of the budget and expenses remains to be a priority. With both COVID GRAM and 4C Mortality, these tools can aid physicians in decision making especially for those at high risk of experiencing a critical event and maybe be used to determine if patients need to be admitted or can be managed at an outpatient basis.