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. 2021 Sep:110:281-308.
doi: 10.1016/j.ijid.2021.07.049. Epub 2021 Jul 24.

ABC2-SPH risk score for in-hospital mortality in COVID-19 patients: development, external validation and comparison with other available scores

Milena S Marcolino  1 , Magda C Pires  2 , Lucas Emanuel F Ramos  3 , Rafael T Silva  4 , Luana M Oliveira  5 , Rafael L R Carvalho  6 , Rodolfo Lucas S Mourato  7 , Adrián Sánchez-Montalvá  8 , Berta Raventós  9 , Fernando Anschau  10 , José Miguel Chatkin  11 , Matheus C A Nogueira  12 , Milton H Guimarães-Júnior  13 , Giovanna G Vietta  14 , Helena Duani  15 , Daniela Ponce  16 , Patricia K Ziegelmann  17 , Luís C Castro  18 , Karen B Ruschel  19 , Christiane C R Cimini  20 , Saionara C Francisco  21 , Maiara A Floriani  22 , Guilherme F Nascimento  23 , Bárbara L Farace  24 , Luanna S Monteiro  25 , Maira V R Souza-Silva  26 , Thais L S Sales  27 , Karina Paula M P Martins  28 , Israel J Borges do Nascimento  29 , Tatiani O Fereguetti  30 , Daniel T M O Ferrara  31 , Fernando A Botoni  32 , Ana Paula B S Etges  33 , Alexandre V Schwarzbold  34 , Amanda O Maurílio  35 , Ana Luiza B A Scotton  36 , André P Weber  37 , André S M Costa  38 , Andressa B Glaeser  39 , Angélica Aparecida C Madureira  40 , Angelinda R Bhering  41 , Bruno Mateus de Castro  42 , Carla Thais C A da Silva  43 , Carolina M Ramos  44 , Caroline D Gomes  45 , Cíntia A de Carvalho  46 , Daniel V Silveira  47 , Edilson Cezar  48 , Elayne C Pereira  49 , Emanuele Marianne S Kroger  50 , Felipe B Vallt  51 , Fernanda B Lucas  52 , Fernando G Aranha  53 , Frederico Bartolazzi  54 , Gabriela P Crestani  55 , Gisele A N Bastos  56 , Glícia Cristina de C Madeira  57 , Helena Carolina Noal  58 , Heloisa R Vianna  59 , Henrique C Guimarães  60 , Isabela M Gomes  61 , Israel Molina  62 , Joanna d'Arc L Batista  63 , Joice C de Alvarenga  64 , Júlia D S S Guimarães  65 , Júlia D P de Morais  66 , Juliana M Rugolo  67 , Karen Cristina J R Pontes  68 , Kauane Aline M Dos Santos  69 , Leonardo S de Oliveira  70 , Lílian S Pinheiro  71 , Liliane S Pacheco  72 , Lucas de D Sousa  73 , Luciana S F Couto  74 , Luciane Kopittke  75 , Luis Cesar S de Moura  76 , Luisa Elem A Santos  77 , Máderson A S Cabral  78 , Maíra D Souza  79 , Marcela G T Tofani  80 , Marcelo Carneiro  81 , Maria Angélica P Ferreira  82 , Maria Aparecida C Bicalho  83 , Maria Clara P B Lima  84 , Mariana F Godoy  85 , Marilia M A Cardoso  86 , Meire P Figueiredo  87 , Natália C S Sampaio  88 , Natália L Rangel  89 , Natália T Crespo  90 , Neimy R de Oliveira  91 , Pedro L Assaf  92 , Petrônio José de L Martelli  93 , Rafaela S C Almeida  94 , Raphael C Martins  95 , Raquel Lutkmeier  96 , Reginaldo Aparecido Valacio  97 , Renan G Finger  98 , Ricardo B Cardoso  99 , Roberta Pozza  100 , Roberta X Campos  101 , Rochele M Menezes  102 , Roger M de Abreu  103 , Rufino de F Silva  104 , Silvana M M Guimarães  105 , Silvia F Araújo  106 , Susany Anastácia Pereira  107 , Talita F Oliveira  108 , Tatiana Kurtz  109 , Thainara C de Oliveira  110 , Thaíza Simônia M A Araújo  111 , Thulio Henrique O Diniz  112 , Veridiana B Dos Santos  113 , Virginia Mara R Gomes  114 , Vitor Augusto L do Vale  115 , Yuri C Ramires  116 , Eric Boersma  117 , Carisi A Polanczyk  118
Affiliations

ABC2-SPH risk score for in-hospital mortality in COVID-19 patients: development, external validation and comparison with other available scores

Milena S Marcolino et al. Int J Infect Dis. 2021 Sep.

Abstract

Objectives: The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones.

Methods: Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March-July, 2020. The model was validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients.

Results: Median (25-75th percentile) age of the model-derivation cohort was 60 (48-72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count, and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829-0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833-0.885]) and Spanish (0.894 [95% CI 0.870-0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/).

Conclusions: An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19.

Keywords: COVID-19; Hospitalizations; Mortality; Prognosis; Risk factors; SARS-CoV-2; Score.

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Figures

Figure 1
Figure 1
Flowchart of COVID-19 patients included in the study.
Figure 2
Figure 2
City of residence of patients within (a) development and (b) validation cohorts.
Figure 3
Figure 3
ABC2-SPH score in derivation and validation cohorts.
Figure 4
Figure 4
Discrimination of ABC2-SPH score in external validation cohorts.
Figure 5
Figure 5
ROC curves (a) and decision curves (b) for best performing scores.
See this image and copyright information in PMC

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