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. 2020 Nov/Dec:91:104240.
doi: 10.1016/j.archger.2020.104240. Epub 2020 Aug 25.

Death risk stratification in elderly patients with covid-19. A comparative cohort study in nursing homes outbreaks

M Bernabeu-Wittel  1 , J E Ternero-Vega  2 , P Díaz-Jiménez  2 , C Conde-Guzmán  2 , M D Nieto-Martín  2 , L Moreno-Gaviño  2 , J Delgado-Cuesta  2 , M Rincón-Gómez  2 , L Giménez-Miranda  2 , M D Navarro-Amuedo  3 , M M Muñoz-García  4 , S Calzón-Fernández  5 , M Ollero-Baturone  2
Affiliations

Death risk stratification in elderly patients with covid-19. A comparative cohort study in nursing homes outbreaks

M Bernabeu-Wittel et al. Arch Gerontol Geriatr. 2020 Nov/Dec.

Abstract

Elderly people are more severely affected by COVID-19. Nevertheless scarce information about specific prognostic scores for this population is available. The main objective was to compare the accuracy of recently developed COVID-19 prognostic scores to that of CURB-65, Charlson and PROFUND indices in a cohort of 272 elderly patients from four nursing homes, affected by COVID-19. Accuracy was measured by calibration (calibration curves and Hosmer-Lemeshov (H-L) test), and discriminative power (area under the receiver operation curve (AUC-ROC). Negative and positive predictive values (NPV and PPV) were also obtained. Overall mortality rate was 22.4 %. Only ACP and Shi et al. out of 10 specific COVID-19 indices could be assessed. All indices but CURB-65 showed a good calibration by H-L test, whilst PROFUND, ACP and CURB-65 showed best results in calibration curves. Only CURB-65 (AUC-ROC = 0.81 [0.75-0.87])) and PROFUND (AUC-ROC = 0.67 [0.6-0.75])) showed good discrimination power. The highest NPV was obtained by CURB-65 (95 % [90-98%]), PROFUND (93 % [77-98%]), and their combination (100 % [82-100%]); whereas CURB-65 (74 % [51-88%]), and its combination with PROFUND (80 % [50-94%]) showed highest PPV. PROFUND and CURB-65 indices showed the highest accuracy in predicting death-risk of elderly patients affected by COVID-19, whereas Charlson and recent developed COVID-19 specific tools lacked it, or were not available to assess. A comprehensive clinical stratification on two-level basis (basal death risk due to chronic conditions by PROFUND index, plus current death risk due to COVID-19 by CURB-65), could be an appropriate approach.

Keywords: COVID-19; CURB-65; Death-risk; Multimorbidity; PROFUND.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work."

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Kaplan-Meier curve comparing survival of nursing homes' residents affected by COVID-19, when stratified by PROFUND index (1.a) and CURB-65 index (1.b), respectively.
Fig. 2
Fig. 2
Discrimination power of analyzed indices by comparison of their area under receiver operator curve in a cohort of nursing home residents with COVID-19 in Seville, Spain. ROC: receiver operator curve; AA: adjusted by age; Barthel: Barthel scale; PROFUND: PROFUND index; Charlson: Charlson index; ACP: ACP index; SHI: Shi el al. index; CURB65: CURB-65 index.
Fig. 3
Fig. 3
Proposed comprehensive approach to elderly patients with COVID-19, based on a two-level risk stratification using PROFUND and CURB-65 indices.
See this image and copyright information in PMC

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