Department of Cardiology, Hospital Universitario La Paz, CiberCV, IdiPaz, Madrid, Spain.
Institute of Cardiovascular Sciences, University of Birmingham, UK.
Europace. 2021 Jun 7;23(6):937-947. doi: 10.1093/europace/euab015.
Age, sex, and cardiovascular disease have been linked to thromboembolic complications and poorer outcomes in COVID-19. We hypothesize that CHADS2 and CHA2DS2-VASc scores may predict thromboembolic events and mortality in COVID-19.
COVID-19 hospitalized patients with confirmed SARS-CoV-2 infection from 1 March to 20 April 2020 who completed at least 1-month follow-up or died were studied. CHADS2 and CHA2DS2-VASc scores were calculated. Given the worse prognosis of male patients in COVID-19, a modified CHA2DS2-VASc score (CHA2DS2-VASc-M) in which 1 point was given to male instead of female was also calculated. The associations of these scores with laboratory results, thromboembolic events, and death were analysed. A total of 3042 patients (mean age 62.3 ± 20.3 years, 54.9% male) were studied and 115 (3.8%) and 626 (20.6%) presented a definite thromboembolic event or died, respectively, during the study period [median follow 59 (50-66) days]. Higher score values were associated with more marked abnormalities of inflammatory and cardiac biomarkers. Mortality was significantly higher with increasing scores for CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-M (P < 0.001 for trend). The CHA2DS2-VASc-M showed the best predictive value for mortality [area under the receiver operating characteristic curve (AUC) 0.820, P < 0.001 for comparisons]. All scores had poor predictive value for thromboembolic events (AUC 0.497, 0.490, and 0.541, respectively).
The CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-M scores are significantly associated with all-cause mortality but not with thromboembolism in COVID-19 patients. They are simple scoring systems in everyday use that may facilitate initial 'quick' prognostic stratification in COVID-19.
年龄、性别和心血管疾病与 COVID-19 中的血栓栓塞并发症和较差的预后有关。我们假设 CHADS2 和 CHA2DS2-VASc 评分可能预测 COVID-19 中的血栓栓塞事件和死亡率。
研究了 2020 年 3 月 1 日至 4 月 20 日期间因确诊 SARS-CoV-2 感染而住院的 COVID-19 患者，这些患者完成了至少 1 个月的随访或死亡。计算了 CHADS2 和 CHA2DS2-VASc 评分。考虑到 COVID-19 中男性患者的预后更差，我们还计算了一种改良的 CHA2DS2-VASc 评分（CHA2DS2-VASc-M），其中男性记 1 分，女性记 0 分。分析了这些评分与实验室结果、血栓栓塞事件和死亡之间的关系。共纳入 3042 例患者（平均年龄 62.3±20.3 岁，54.9%为男性），研究期间分别有 115 例（3.8%）和 626 例（20.6%）出现明确的血栓栓塞事件或死亡[中位随访 59（50-66）天]。评分值越高，炎症和心脏标志物的异常越明显。随着 CHADS2、CHA2DS2-VASc 和 CHA2DS2-VASc-M 评分的增加，死亡率显著升高（趋势 P<0.001）。CHA2DS2-VASc-M 对死亡率的预测价值最佳[受试者工作特征曲线下面积（AUC）0.820，与其他评分比较 P<0.001]。所有评分对血栓栓塞事件的预测价值均较低（AUC 分别为 0.497、0.490 和 0.541）。
CHADS2、CHA2DS2-VASc 和 CHA2DS2-VASc-M 评分与 COVID-19 患者的全因死亡率显著相关，但与血栓栓塞事件无关。它们是日常使用的简单评分系统，可能有助于 COVID-19 患者的初始“快速”预后分层。
