The validation of the original and modified Caprini score in COVID-19 patients

Abstract

Objective. The study aimed to validate the original Caprini score and its modifications considering coronavirus disease (COVID-19) as a severe prothrombotic condition in patients admitted to the hospital with confirmed infection. Methods. The relevant data were extracted from the electronic medical records with the implemented Caprini score and were evaluated retrospectively. The score was calculated twice: by the physician at the admission and by the investigator at discharge or after death. The second calculation at discharge, considered additional risk factors that occurred during inpatient treatment. Besides the original Caprini score (a version of 2005), the modified version added the elevation of D-dimer and specific scores for COVID-19 as follows: 2 points for asymptomatic, 3 points for symptomatic and 5 points for symptomatic infection with positive D-dimer, were evaluated in a retrospective manner. The primary endpoint was symptomatic venous thromboembolism (VTE) confirmed by appropriate imaging testing or dissection. The secondary endpoint included the unfavorable outcome as a combination of symptomatic VTE, admission to the intensive care unit, the requirement for invasive mechanical ventilation, and death. The association of eight different versions of the Caprini score with outcomes was evaluated. Results. Totally 168 patients (83 males and 85 females at the age of 58.3±12.7 years old) were admitted to the hospital between April 30 and May 29, 2020, and were discharged or died up to the time of data analysis. The original Caprini score varied between 2-12 (5.4±1.8) at the admission and between 2-15 (5.9±2.5) at discharge or death. The presence of the virus increased these scores and resulted in an increased score with the maximal value for those including COVID-19 points (10.0±3.0). Patients received prophylactic (2.4%), intermediate (76.8%), or therapeutic (20.8%) doses of enoxaparin. Despite this, the symptomatic VTE was detected in 11 (6.5%) and unfavorable outcomes in 31 (18.5%) patients. The Caprini score of all eight versions demonstrated a significant association with VTE with the highest predictability for the original scale when assessed at discharge. Supplementation of the original score by elevated D-dimer improved predictability only at the admission. Four versions of the Caprini score calculated at the admission had a significant correlation with the unfavorable outcome with the minor advantages of specific COVID-19 points. Conclusion. The study identified a significant correlation between the Caprini score and the risk of VTE or unfavorable outcomes in COVID-19 patients. All models, including specific COVID-19 scores, showed high predictability with minor differences.

Validation of the IMPROVE‐DD risk assessment model for venous thromboembolism among hospitalized patients with COVID‐19

“…The model’s AUC of 70%, sensitivity of 97%, and specificity of 22% are in line with previous validation studies of routinely used medical VTE RAMs (eg, Khorana and IMPROVE VTE scores) 11,14 . Previous efforts using VTE risk scores in hospitalized patients with COVID‐19 were underpowered, used surrogate outcomes, or included ad hoc risk factors that were not included within the original derivation study 15,16 . In our study, nearly half of patients had elevated Dd, approximately 25% had an ICU stay, and >60% were above age 60.…”

Incidence of deep venous thrombosis in COVID-19 hospitalized patients during the first peak of the Italian outbreak

“…7,12,13 Recently have been presented promising results with the use of the Caprini score and its updated version for COVID-19, which demonstrated a significant correlation with VTE and unfavorable outcomes in a single-center study on 168 COVID-19 patients. 30…”

Recomendaciones en el tratamiento de la enfermedad tromboembólica venosa en pacientes con infección por COVID-19

“…Una de las escalas más utilizadas desde 1991 para la determinación del riesgo de trombosis en pacientes quirúrgicos fue diseñada por Caprini, et al 11 , y logró ser la base para varias modificaciones de acuerdo con el estado del paciente. En un artículo publicado recientemente por Tsaplin, et al 12 , con contribución del mismo Dr. Joseph Caprini, se propone una modificación de esta misma escala para pacientes con infección grave por SARS-CoV2, lo que llamaron como escala de CA-PRINI-COVID-19. Esta escala adiciona la sintomatología del COVID-19, con o sin elevación del dímero D, determinando que cualquiera de las modificaciones de la escala de Caprini tiene una correlación significativa con el riesgo de ETV o evolución desfavorable, con alto índice de predicción.…”