Mortality prediction using a modified R2CHA2DS2-VASc score among hospitalized COVID-19 patients

Abstract

The CHA 2 DS 2 -VASc score incorporates several comorbidities which have prognostic implications in COVID-19. We assessed whether a modified score (M-R 2 CHA 2 DS 2 -VASc), which includes pre-admission kidney function and male sex, could be used to classify mortality risk among people hospitalized with COVID-19. This retrospective study included adults admitted for COVID-19 between March and December 2020. Pre-admission glomerular filtration rate (GFR) was calculated based on serum creatinine and used for scoring M-R 2 CHA 2 DS 2 -VASc. Participants were categorized according to the M-R 2 CHA 2 DS 2 -VASc categories as 0–1 (low), 2–3 (intermediate), or ≥ 4 (high), and according to initial COVID-19 severity score. The primary outcome was 30-day mortality rates. Secondary outcomes were mortality rates over time, and rates of mechanical ventilation, hemodynamic support, and renal replacement therapy. Eight hundred hospitalizations met the study criteria. Participants were 55% males, average age was 65.2 ± 17 years. There were similar proportions of subjects across the M-R 2 CHA 2 DS 2 -VASc categories. 30-day mortality was higher in those in higher M-R 2 CHA 2 DS 2 -VASc category and with severe or critical COVID-19 at admission. Subjects in the low, intermediate, and high M-R 2 CHA 2 DS 2 -VASc categories had 30-day mortality rates of 4.7%, 17% and 31%, respectively ( p < 0.001). Higher category was also associated with increased need for mechanical ventilation and renal replacement therapy. All-cause 90-day mortality remained significantly associated with M-R 2 CHA 2 DS 2 -VASc. The M-R 2 CHA 2 DS 2 -VASc score is associated with 30-day mortality rates among patients hospitalized with COVID-19, and adds predictive value when combined with initial COVID-19 severity.

Handgrip strength is associated with adverse outcomes in patients hospitalized for COVID-19-associated pneumonia

“…Indeed, in our population, each decrease in 10 kg/ Kg 2/3 upper arm muscle strength was associated to a nearly twofold risk of endotracheal intubation. We also found, in line with previous reports [19], that a positive history of CV diseases and reduced eGFR also independently predicted adverse clinical outcomes in COVID-19-related pneumonia.…”

Predicting mortality in hospitalized COVID-19 patients

“…Recent findings showed that the CHA 2 DS 2 -VASc score and its modified forms can differentiate patients at higher risk of worse outcome in course of SARS-CoV-2 infection [16][17][18]. Our comment concerns the article by Levy et al in the current issue of Internal and Emergency Medicine that evaluated the role of the modified R 2 CHA 2 DS 2 -VASc (M-R 2 CHA 2 DS 2 -VASc) score on the prediction of mortality in hospitalized patients with SARS-CoV-2 infection [19].…”

Humoral Response to Hepatitis B and COVID-19 Vaccine among Maintenance Hemodialysis Patients

“…MHD patients are immunocompromised and may have other risk-factors associated with their primary renal disease, such as older age, diabetes, hypertension, etc. As such, they were found to be at increased risk for severe disease and mortality [ 16 , 17 , 18 , 19 ]. Therefore, with the release of the SARS-CoV-2 mRNA vaccine, MHD patients were prioritized for vaccination.…”