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

Milena S. Marcolino*, Magda C. Pires, Lucas Emanuel F. Ramos, Rafael T. Silva, Luana M. Oliveira, Rafael L.R. Carvalho, Rodolfo Lucas S. Mourato, Adrián Sánchez-Montalvá, Berta Raventós, Fernando Anschau, José Miguel Chatkin, Matheus C.A. Nogueira, Milton H. Guimarães-Júnior, Giovanna G. Vietta, Helena Duani, Daniela Ponce, Patricia K. Ziegelmann, Luís C. Castro, Karen B. Ruschel, Christiane C.R. CiminiSaionara C. Francisco, Maiara A. Floriani, Guilherme F. Nascimento, Bárbara L. Farace, Luanna S. Monteiro, Maira V.R. Souza-Silva, Thais L.S. Sales, Karina Paula M.P. Martins, Israel J. Borges do Nascimento, Tatiani O. Fereguetti, Daniel T.M.O. Ferrara, Fernando A. Botoni, Ana Paula B.S. Etges, Alexandre V. Schwarzbold, Amanda O. Maurílio, Ana Luiza B.A. Scotton, André P. Weber, André S.M. Costa, Andressa B. Glaeser, Angélica Aparecida C. Madureira, Angelinda R. Bhering, Bruno Mateus de Castro, Carla Thais C.A. da Silva, Carolina M. Ramos, Caroline D. Gomes, Cíntia A. de Carvalho, Daniel V. Silveira, Edilson Cezar, Elayne C. Pereira, Emanuele Marianne S. Kroger, Felipe B. Vallt, Fernanda B. Lucas, Fernando G. Aranha, Frederico Bartolazzi, Gabriela P. Crestani, Gisele A.N. Bastos, Glícia Cristina de C. Madeira, Helena Carolina Noal, Heloisa R. Vianna, Henrique C. Guimarães, Isabela M. Gomes, Israel Molina, Joanna d.Arc L. Batista, Joice C. de Alvarenga, Júlia D.S.S. Guimarães, Júlia D.P. de Morais, Juliana M. Rugolo, Karen Cristina J.R. Pontes, Kauane Aline M. dos Santos, Leonardo S. de Oliveira, Lílian S. Pinheiro, Liliane S. Pacheco, Lucas de D. Sousa, Luciana S.F. Couto, Luciane Kopittke, Luis Cesar S. de Moura, Luisa Elem A. Santos, Máderson A.S. Cabral, Maíra D. Souza, Marcela G.T. Tofani, Marcelo Carneiro, Maria Angélica P. Ferreira, Maria Aparecida C. Bicalho, Maria Clara P.B. Lima, 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 L. Martelli, Rafaela S.C. Almeida, Raphael C. Martins, Raquel Lutkmeier, Reginaldo Aparecido Valacio, 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. Guimarães, Silvia F. Araújo, Susany Anastácia Pereira, Talita F. Oliveira, Tatiana Kurtz, Thainara C. de Oliveira, Thaíza Simônia M.A. Araújo, Thulio Henrique O. Diniz, Veridiana B. dos Santos, Virginia Mara R. Gomes, Vitor Augusto L. do Vale, Yuri C. Ramires, Eric Boersma, Carisi A. Polanczyk

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objectives: 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. 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 (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/). Conclusions: 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.

Original languageEnglish
Pages (from-to)281-308
Number of pages28
JournalInternational Journal of Infectious Diseases
Volume110
Early online date23 Jul 2021
DOIs
Publication statusPublished - 1 Sep 2021

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Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

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