Usefulness of the C2HEST Score in Predicting the Clinical Outcomes of COVID-19 in Diabetic and Non-Diabetic Cohorts

Abstract

Background: Diabetes mellitus is among the most frequent comorbidities worsening COVID-19 outcome. Nevertheless, there are no data regarding the optimal risk stratification of patients with diabetes and COVID-19. Since individual C2HEST components reflect the comorbidities, we assumed that the score could predict COVID-19 outcomes. Material and Methods: A total of 2184 medical records of patients hospitalized for COVID-19 at the medical university center were analyzed, including 473 diabetic patients and 1666 patients without any glucose or metabolic abnormalities. The variables of patients’ baseline characteristics were retrieved to calculate the C2HEST score and subsequently the diabetic and non-diabetic subjects were assigned to the following categories: low-, medium- or high-risk. The measured outcomes included: in-hospital mortality; 3-month and 6-month all-cause mortality; non-fatal end of hospitalization (discharged home/sudden-deterioration/rehabilitation) and adverse in-hospital clinical events. Results: A total of 194 deaths (41%) were reported in the diabetic cohort, including 115 in-hospital deaths (24.3%). The 3-month and 6-month in-hospital mortality was highest in the high-risk C2HEST stratum. The C2HEST score revealed to be more sensitive in non-diabetic-group. The estimated six-month survival probability for high-risk subjects reached 0.4 in both cohorts whereas for the low-risk group, the six-month survival probability was 0.7 in the diabetic vs. 0.85 in the non-diabetic group—levels which were maintained during whole observation period. In both cohorts, receiver operating characteristics revealed that C2HEST predicts the following: cardiogenic shock; acute heart failure; myocardial injury; and in-hospital acute kidney injury. Conclusions: We demonstrated the usefulness and performance of the C2HEST score in predicting the adverse COVID-19 outcomes in hospitalized diabetic subjects.

Usefulness of C2HEST Score in Predicting Clinical Outcomes of COVID-19 in Heart Failure and Non-Heart-Failure Cohorts

“…Those data are additionally visualized in Kaplan–Maier curves for the heart failure cohort ( Figure 4 ). A similar observation was previously made in terms of other COVID-19 strong risk factors (diabetes and coronary artery diseases) [ 9 ]. On the other hand, in the non-HF cohort, we observed significantly better performance of C 2 HEST scores in terms of morality discriminatory ability.…”

“…Unfortunately, a simple, fast, well-validated scoring system dedicated to the HF subpopulation is still missing. Taking into account some encouraging data from our previous analyses concerning other subpopulations of COVID-19 patients [ 8 , 9 , 19 ], we decided to validate the C 2 HEST score system in terms of heart failure subjects.…”

“…However, recently, Liang et al [ 7 ] demonstrated that C 2 HEST score could also predict adverse clinical outcomes, including death and hospitalization, among patients with heart failure. Considering that individual components of the C 2 HEST (C2: CAD/COPD; H: Hypertension; E: Elderly (Age ≥ 75); S: Systolic HF; T: Thyroid disease) are parallel to COVID-19 mortality risk factors, juxtaposing it with the outcomes of recently published studies [ 8 , 9 , 10 ] suggesting that this simple scoring system has the ability to predict outcomes in several COVID-19 subpopulations, we designed this study to evaluate the predictive value of C 2 HEST score in patients with heart failure (HF).…”