Objectives
Predictive scores are important tools for triage of COVID-19 patients. The PRIORITY score is advantageous as it does not require laboratory and radiologic information, however the original development and validation cohorts studied only unvaccinated patients in early 2020. We aimed to externally validate the PRIORITY score in a cohort of COVID-19 patients with novel Delta and Omicron variants and mixed vaccination status.
Methods
410 patients were included in a cross-sectional sampling of all patients admitted in the National Centre of Infectious Diseases on 27-October-2021. A further 102 patients and 136 patients with vaccine-breakthrough Delta and Omicron variant infection from April-August and December-2021 respectively were also included. Variables on admission were collected retrospectively from the medical record and used to calculate the probability of deterioration using the PRIORITY model.
Results
Of the total 648 included patients, 447 (69.0%) were vaccinated. Mean age was 61.6 (SD ±19.0) years, and 268 (41.4%) patients were female. 112 (17.3%) met the primary outcome of developing critical illness or mortality. Performance of the score in this cohort was comparable to the original cohorts, with an AUC for all patients of 0.794 (95% CI 0.752–0.835, p<0.001), regression coefficient of 1.069 and intercept of 0.04. Subgroup analysis of unvaccinated and vaccinated patients showed that performance was superior in vaccinated individuals, with AUC of 0.684 (95% CI 0.608–0.760, p<0.0001) and 0.831 (0.772–0.891, p<0.0001) respectively.
Conclusions
Our data support the continued use of the PRIORITY score in this era of novel variants and increased vaccination uptake.
Early treatment of high‐risk COVID‐19 patients may prevent disease progression. However, there are limited data to support treatment of hospitalized or fully vaccinated patients with mild‐to‐moderate disease. In this retrospective cohort study, we studied the effect of early use of sotrovimab and remdesivir in high‐risk hospitalized COVID‐19 patients. We included PCR‐confirmed COVID‐19 patients admitted to the National Centre for Infectious Diseases who presented within the first 5 days of illness, and who were not requiring oxygen or ICU care at presentation. Sotrovimab‐ and remdesivir‐treated groups were compared with control (no early treatment). A multiple propensity‐score adjusted multivariable regression analysis was conducted with a composite primary endpoint of in‐hospital deterioration (oxygen requirement, ICU admission, or mortality). Of 1118 patients, 841 were in the control group, 106 in the sotrovimab group and 169 in the remdesivir group. The median age was 63 years (IQR 46–74 years) and 505 (45.2%) were female. In unvaccinated patients, both remdesivir and sotrovimab treatment were protective (adjusted odds ratio [aOR] 0.19, 95% CI 0.064–0.60 and 0.18 [95% CI 0.066–0.47]), respectively. Contrarily, among the vaccinated patients there was no significant treatment effect with early remdesivir treatment (aOR 2.51, 95% CI 0.83–7.57, p = 0.10). Remdesivir and sotrovimab treatment, given early in the disease course to unvaccinated high‐risk patients, was effective in reducing the risk of in‐hospital deterioration and severe disease. This effect was not seen in fully vaccinated patients, which may be due to a small sample size or residual confounding.
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