Usefulness of the CHA2DS2-VASc Score in Predicting the Outcome in Subjects Hospitalized with COVID-19-A Subanalysis of the COLOS Study

Abstract

Background: The aim of this study was to see if the CHA₂DS₂-VASc score (Cardiac failure or dysfunction, Hypertension, Age ≥ 75 [Doubled], Diabetes, Stroke [Doubled]-Vascular disease, Age 65-74 and Sex category [Female] score) could have potential clinical relevance in predicting the outcome of hospitalization time, need for ICU hospitalization, survival time, in-hospital mortality, and mortality at 3 and 6 months after discharge home.

Materials: A retrospective analysis of 2183 patients with COVID-19 hospitalized at the COVID-19 Centre of the University Hospital in Wrocław, Poland, between February 2020 and June 2021, was performed. All medical records were collected as part of the COronavirus in LOwer Silesia-the COLOS registry project. The CHA₂DS₂-VASc score was applied for all subjects, and the patients were observed from admission to hospital until the day of discharge or death. Further information on patient deaths was prospectively collected following the 90 and 180 days after admission. The new risk stratification derived from differences in survival curves and long-term follow-up of our patients was obtained. Primary outcomes measured included in-hospital mortality and 3-month and 6-month all-cause mortality, whereas secondary outcomes included termination of hospitalization from causes other than death (home discharges/transfer to another facility or deterioration/referral to rehabilitation) and non-fatal adverse events during hospitalization.

Results: It was shown that gender had no effect on mortality. Significantly shorter hospitalization time was observed in the group of patients with low CHA₂DS₂-VASc scores. Among secondary outcomes, CHA₂DS₂-VASc score revealed predictive value in both genders for cardiogenic (5.79% vs. 0.69%; p < 0.0001), stroke/TIA (0.48% vs. 9.92%; p < 0.0001), acute heart failure (0.97% vs. 18.18%; p < 0.0001), pneumonia (43% vs. 63.64%; p < 0.0001), and acute renal failure (7.04% vs. 23.97%; p < 0.0001). This study points at the usefulness of the CHA₂DS₂-VASc score in predicting the severity of the course of COVID-19.

Conclusions: Routine use of this scale in clinical practice may suggest the legitimacy of extending its application to the assessment of not only the risk of thromboembolic events in the COVID-19 cohort.

Keywords: CHA2DS2-VASc—score; COVID-19; SARS-CoV2; mortality; outcomes.

Figure 1

A flowchart presenting the study protocol.

Figure 2

The changes in the area under the receiver operating characteristic curve (AUC) for CHA₂DS₂-VASc predictive abilities of all-cause death in relation to time. Explanations: AUC(t)—area under receiver operating curve as a function of time (solid line); dashed lines determine 95% confidence intervals.

Figure 3

Time-dependent receiver operating characteristic curves (time–ROC) for the CHA₂DS₂-VASc score in predicting total mortality, determined every 30 days in the analyzed follow-up period.