Comparison of CHA₂DS₂VASc and R₂CHA₂DS₂VASc score estimation of in-hospital mortality among COVID-19 patients

Abstract

Objectives: This study aims to compare of CHA₂DS₂VASc and R₂CHA₂DS₂VASc score estimation of in-hospital mortality among COVID-19 patients and find a new scoring system that can better predict the hospital mortality by adding some laboratory parameters to the CHA₂DS₂VASc and R₂CHA₂DS₂VASc scores. Methods: This is a cross-sectional study. A total of 1076 COVID-19 patients with confirmed COVID-19 PCR tests were included from September 2020 to March 2021. Age, sex, comorbidity, laboratory, survival times, and death status of the patients were recorded. The scores CHA₂DS₂VASc and R₂CHA₂DS₂VASc of each patient were calculated. A new mortality prediction score was created to establish the most effective model with logistic regression analysis, including laboratory values. Results: Of the 1076 patients hospitalized for COVID-19, 15.1% died, while 84.9% survived. There was no significant difference between the two groups in sex. All comorbidities were significantly higher in the deceased than in the survivors (p<0.001). The survivors' hemoglobin, thrombocyte, and eGFR values were significantly higher. The C-reactive protein (CRP), aspartate aminotransferase (AST), and neutrophil-to-lymphocyte ratio (NLR) were found to be associated with mortality, and the CAN-R₂CHA₂DS₂VASc score was created by including these three laboratory parameters. The ROC curves of the scores CHA₂DS₂VASc (AUC=0.810), R₂CHA₂DS₂VASc (AUC=0.824), and CAN-R₂CHA₂DS₂VASc (AUC=0.909) were analyzed. The CAN-R₂CHA₂DS₂VASc score was superior to other scores (p<0.001). The sensitivity and specificity of the CAN-R₂CHA₂DS₂VASc score were 79.8% and 86.5%, respectively, while the criterion was >6 points. Conclusion: The CAN-R₂CHA₂DS₂VASc score is a useful tool for estimating hospital mortality in COVID-19 patients. The CAN-R₂CHA₂DS₂VASc score was superior to the R₂CHA₂DS₂VASc and CHA₂DS₂VASc score in predicting in-hospital mortality.

Keywords

• COVID-19
• mortality
• hospitalization
• survival
• comorbidity
• risk factors

COVID-19 hastalarında hastane içi mortalitenin CHA₂DS₂VASc ve R₂CHA₂DS₂VASc skor tahmininin karşılaştırılması

Abstract

Amaç: Bu çalışma, COVID-19 hastalarında hastane içi mortalitenin CHA₂DS₂VASc ve R₂CHA₂DS₂VASc skor tahminini karşılaştırmayı ve CHA₂DS₂VASc ve R₂CHA₂DS₂VASc skorlarına bazı laboratuvar parametreleri ekleyerek hastane mortalitesini daha iyi tahmin edebilen yeni bir skorlama sistemi bulmayı amaçlamaktadır. Method: Bu bir kesitsel çalışmadır. Eylül 2020'den Mart 2021'e kadar COVID-19 PCR testleri doğrulanmış toplam 1076 COVID-19 hastası dahil edildi. Hastaların yaş, cinsiyet, komorbidite, laboratuvar, hayatta kalma süreleri ve ölüm durumları kaydedildi. Her hastanın CHA₂DS₂VASc ve R₂CHA₂DS₂VASc skorları hesaplandı. Laboratuvar değerleri de dahil olmak üzere lojistik regresyon analizi ile en etkili modeli oluşturmak için yeni bir ölüm tahmin skoru oluşturuldu. Bulgular: COVID-19 nedeniyle hastaneye yatırılan 1076 hastanın %15,1'i öldü, %84,9'u hayatta kaldı. İki grup arasında cinsiyet açısından anlamlı fark yoktu. Ölenlerde tüm komorbiditeler yaşayanlara göre anlamlı derecede yüksekti (p<0.001). Hayatta kalanların hemoglobin, trombosit ve eGFR değerleri anlamlı olarak daha yüksekti. C-reaktif protein (CRP), aspartat aminotransferaz (AST) ve nötrofil-lenfosit oranı (NLR) mortalite ile ilişkili bulundu ve bu üç laboratuvar parametresi dahil edilerek CAN-R₂CHA₂DS₂VASc skoru oluşturuldu. CHA₂DS₂VASc (AUC=0,810), R₂CHA₂DS₂VASc (AUC=0,824) ve CAN-R₂CHA₂DS₂VASc (AUC=0,909) skorlarının ROC eğrileri analiz edildi. CAN-R₂CHA₂DS₂VASc skoru diğer skorlardan üstündü (p<0.001). CAN-R₂CHA₂DS₂VASc skorunun duyarlılığı ve özgüllüğü sırasıyla %79,8 ve %86,5 iken, kriter >6 puandı. Sonuç: CAN-R₂CHA₂DS₂VASc skoru, COVID-19 hastalarında hastane mortalitesini tahmin etmek için yararlı bir araçtır. CAN-R₂CHA₂DS₂VASc skoru, hastane içi mortaliteyi tahmin etmede R₂CHA₂DS₂VASc ve CHA₂DS₂VASc skorundan üstündü.

Keywords

• COVID-19
• risk faktörleri
• eşzamanlı hastalık
• ölüm oranı
• yataklı tedavi
• sağ kalım

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