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. 2022 Sep 2;20(1):324.
doi: 10.1186/s12916-022-02503-0.

Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients

Flávio de Azevedo Figueiredo  1   2 , Lucas Emanuel Ferreira Ramos  3 , Rafael Tavares Silva  3 , Daniela Ponce  4 , Rafael Lima Rodrigues de Carvalho  5 , Alexandre Vargas Schwarzbold  6 , Amanda de Oliveira Maurílio  7 , Ana Luiza Bahia Alves Scotton  8 , Andresa Fontoura Garbini  9 , Bárbara Lopes Farace  10 , Bárbara Machado Garcia  11 , Carla Thais Cândida Alves da Silva  12 , Christiane Corrêa Rodrigues Cimini  13   14 , Cíntia Alcantara de Carvalho  15 , Cristiane Dos Santos Dias  16 , Daniel Vitório Silveira  17 , Euler Roberto Fernandes Manenti  18 , Evelin Paola de Almeida Cenci  19 , Fernando Anschau  9 , Fernando Graça Aranha  20 , Filipe Carrilho de Aguiar  21 , Frederico Bartolazzi  12 , Giovanna Grunewald Vietta  20 , Guilherme Fagundes Nascimento  17 , Helena Carolina Noal  6 , Helena Duani  22 , Heloisa Reniers Vianna  23 , Henrique Cerqueira Guimarães  10 , Joice Coutinho de Alvarenga  15 , José Miguel Chatkin  24 , Júlia Drumond Parreiras de Morais  23 , Juliana Machado-Rugolo  4 , Karen Brasil Ruschel  5   18 , Karina Paula Medeiros Prado Martins  5   22 , Luanna Silva Monteiro Menezes  25   26 , Luciana Siuves Ferreira Couto  27 , Luís César de Castro  28 , Luiz Antônio Nasi  29 , Máderson Alvares de Souza Cabral  22 , Maiara Anschau Floriani  29 , Maíra Dias Souza  26 , Maira Viana Rego Souza-Silva  30 , Marcelo Carneiro  31 , Mariana Frizzo de Godoy  24 , Maria Aparecida Camargos Bicalho  30   11 , Maria Clara Pontello Barbosa Lima  27 , Márlon Juliano Romero Aliberti  32   33 , Matheus Carvalho Alves Nogueira  34 , Matheus Fernandes Lopes Martins  35 , Milton Henriques Guimarães-Júnior  35 , Natália da Cunha Severino Sampaio  36 , Neimy Ramos de Oliveira  36 , Patricia Klarmann Ziegelmann  5   37 , Pedro Guido Soares Andrade  38 , Pedro Ledic Assaf  39 , Petrônio José de Lima Martelli  21 , Polianna Delfino-Pereira  30   5 , Raphael Castro Martins  37 , Rochele Mosmann Menezes  31 , Saionara Cristina Francisco  39 , Silvia Ferreira Araújo  38 , Talita Fischer Oliveira  26 , Thainara Conceição de Oliveira  19 , Thaís Lorenna Souza Sales  5   40 , Thiago Junqueira Avelino-Silva  32   41 , Yuri Carlotto Ramires  28 , Magda Carvalho Pires  3 , Milena Soriano Marcolino  30   5   22   42
Affiliations

Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients

Flávio de Azevedo Figueiredo et al. BMC Med. .

Erratum in

  • Correction: Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients.
    de Azevedo Figueiredo F, Ramos LEF, Silva RT, Ponce D, de Carvalho RLR, Schwarzbold AV, de Oliveira Maurílio A, Scotton ALBA, Garbini AF, Farace BL, Garcia BM, da Silva CTCA, Cimini CCR, de Carvalho CA, Dos Santos Dias C, Silveira DV, Manenti ERF, de Almeida Cenci EP, Anschau F, Aranha FG, de Aguiar FC, Bartolazzi F, Vietta GG, Nascimento GF, Noal HC, Duani H, Vianna HR, Guimarães HC, de Alvarenga JC, Chatkin JM, de Morais JDP, Machado-Rugolo J, Ruschel KB, Martins KPMP, Menezes LSM, Couto LSF, de Castro LC, Nasi LA, de Souza Cabral MA, Floriani MA, Souza MD, Souza-Silva MVR, Carneiro M, de Godoy MF, Bicalho MAC, Lima MCPB, Aliberti MJR, Nogueira MCA, Martins MFL, Guimarães-Júnior MH, da Cunha Severino Sampaio N, de Oliveira NR, Ziegelmann PK, Andrade PGS, Assaf PL, de Lima Martelli PJ, Delfino-Pereira P, Castro Martins R, Menezes RM, Francisco SC, Araújo SF, Oliveira TF, de Oliveira TC, Souza Sales TL, Avelino-Silva TJ, Ramires YC, Pires MC, Marcolino MS. de Azevedo Figueiredo F, et al. BMC Med. 2023 Jun 6;21(1):207. doi: 10.1186/s12916-023-02912-9. BMC Med. 2023. PMID: 37280651 Free PMC article. No abstract available.

Abstract

Background: Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement.

Methods: This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC).

Results: The median age of the model-derivation cohort was 59 (IQR 47-70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918-0.939) and validation (temporal AUROC 0.927, 95% CI 0.911-0.941; geographic AUROC 0.819, 95% CI 0.792-0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ).

Conclusions: The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation.

Keywords: Acute kidney injury; COVID-19; Kidney replacement therapy; Risk factors; Risk prediction; Score.

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Conflict of interest statement

The authors declare that they have no competing interests. The sponsors had no role in study design; data collection, management, analysis, and interpretation; writing the manuscript; and deciding to submit it for publication.

Figures

Fig. 1
Fig. 1
Flowchart of COVID-19 patients included in the study
Fig. 2
Fig. 2
City of residence of patients from a development and b temporal validation cohorts
Fig. 3
Fig. 3
ROC curve from derivation cohort
Fig. 4
Fig. 4
ROC curves from and temporal and geographic validation cohorts
See this image and copyright information in PMC

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