Abstract
Objective: Coronavirus disease 2019 (COVID-19) is a disease with a high rate of progression to critical illness. However, the stratification of patients at risk of mortality is not well defined. In this study, we aimed to define a mortality risk index to allocate patients to the appropriate intensity of care.Methods: This is a 12 months observational longitudinal study designed to develop and validate a pragmatic mortality risk score to stratify COVID-19 patients aged ≥18 years and admitted to hospital between March 2020 and March 2021. Main outcome was in-hospital mortality.Results: 244 patients were included in the study (mortality rate 29.9%). The Covid-19 Assessment for Survival at Admission (CASA) index included seven variables readily available at admission: respiratory rate, troponin, albumin, CKD-EPI, white blood cell count, D-dimer, Pa02/Fi02. The CASA index showed high discrimination for mortality with an AUC of 0.91 (sensitivity 98.6%; specificity 69%) and a better performance compared to SOFA (AUC = 0.76), age (AUC = 0.76) and 4C mortality (AUC = 0.82). The cut-off identified (11.994) for CASA index showed a negative predictive value of 99.16% and a positive predictive value of 57.58%.Conclusions: A quick and readily available index has been identified to help clinicians stratify COVID-19 patients according to the appropriate intensity of care and minimize hospital admission to patients at high risk of mortality.
Highlights
Since the outbreak in Wuhan city, China on December 2019 of a viral pneumonia with an unidentified etiology [1], a novel strain of coronavirus was isolated and defined Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) by the Coronaviridae Study Group (CSG) of the International Committee on Taxonomy of VirusesCOVID-19 Stratification Risk for Survival [2]
The overwhelming number of SarsCov-2 infected patients requiring hospitalization outpaces the availability of human and medical resources in several countries. All these conditions argue for the definition of a very high performing, predictive index of mortality to allow the appropriate allocation of COVID-19 resources [3]
History of chronic kidney disease, coronary artery disease and heart failure were more frequent in deceased patients, while no differences were found for hypertension or diabetes prevalence
Summary
Since the outbreak in Wuhan city, China on December 2019 of a viral pneumonia with an unidentified etiology [1], a novel strain of coronavirus was isolated and defined Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) by the Coronaviridae Study Group (CSG) of the International Committee on Taxonomy of VirusesCOVID-19 Stratification Risk for Survival [2]. The overwhelming number of SarsCov-2 infected patients requiring hospitalization outpaces the availability of human and medical resources in several countries All these conditions argue for the definition of a very high performing, predictive index of mortality to allow the appropriate allocation of COVID-19 resources [3]. Clinicians and health care systems urgently warrant reliable scores to identify those patients with COVID-19 at highest risk for death requiring admission, to stratify them in the appropriate level of care and apply a rational optimization of resources. These instruments can help clinician adopt quick and reliable clinical decisions and anticipate the prognosis to patients and their families
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