Rola Piotr, Doroszko Adrian, Trocha Małgorzata, Giniewicz Katarzyna, Kujawa Krzysztof, Gawryś Jakub, Matys Tomasz, Gajecki Damian, Madziarski Marcin, Zieliński Stanisław, Skalec Tomasz, Drobnik Jarosław, Sebastian Agata, Zubkiewicz-Zarębska Anna, Adamik Barbara, Kaliszewski Krzysztof, Kiliś-Pstrusinska Katarzyna, Matera-Witkiewicz Agnieszka, Pomorski Michał, Protasiewicz Marcin, Sokołowski Janusz, Włodarczak Szymon, Jankowska Ewa Anita, Madziarska Katarzyna
Department of Cardiology, Provincial Specialized Hospital, Iwaszkiewicza Street 5, 59-220 Legnica, Poland.
Clinical Department of Internal Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
J Clin Med. 2022 Jun 17;11(12):3495. doi: 10.3390/jcm11123495.
Background: Patients with heart failure represent a vulnerable population for COVID-19 and are prone to having worse prognoses and higher fatality rates. Still, the clinical course of the infection is dynamic, and complication occurrence in particular in patients with heart failure is fairly unpredictable. Considering that individual components of the C2HEST (C2: Coronary Artery Diseases (CAD)/Chronic obstructive pulmonary disease (COPD); H: Hypertension; E: Elderly (Age ≥ 75); S: Systolic HF; T: Thyroid disease) are parallel to COVID-19 mortality risk factors, we evaluate the predictive value of C2HEST score in patients with heart failure (HF) Material and Methods: The retrospective medical data analysis of 2184 COVID-19 patients hospitalized in the University Hospital in Wroclaw between February 2020 and June 2021 was the basis of the study. The measured outcomes included: in-hospital mortality, 3-month and 6-month all-cause-mortality, non-fatal end of hospitalization, and adverse in-hospital clinical events. Results: The heart failure cohort consists of 255 patients, while 1929 patients were assigned to the non-HF cohort. The in-hospital, 3-month, and 6-month mortality rates were highest in the HF cohort high-risk C2HEST stratum, reaching 38.61%, 53.96%, and 65.36%, respectively. In the non-HF cohort, in-hospital, 3-month, and 6-month mortalities were also highest in the high-risk C2HEST stratum and came to 26.39%, 52.78%, and 65.0%, respectively. An additional point in the C2HEST score increased the total death intensity in 10% of HF subjects (HR 1.100, 95% CI 0.968−1.250 p = 0.143) while in the non-HF cohort, the same value increased by 62.3% (HR 1.623, 95% CI 1.518−1.734 p < 0.0001). Conclusions: The C2HEST score risk in the HF cohort failed to show discriminatory performance in terms of mortality and other clinical adverse outcomes during hospitalization. C2HEST score in the non-HF cohort showed significantly better performance in terms of predicting in-hospital and 6-month mortality and other non-fatal clinical outcomes such as cardiovascular events (myocardial injury, acute heart failure, myocardial infarction, cardiogenic shock), pneumonia, sepsis, and acute renal injury.
心力衰竭患者是感染新型冠状病毒肺炎（COVID-19）的易感人群，预后较差，病死率较高。然而，感染的临床过程是动态变化的，尤其是心力衰竭患者的并发症发生情况相当难以预测。鉴于C2HEST（C2：冠状动脉疾病（CAD）/慢性阻塞性肺疾病（COPD）；H：高血压；E：老年人（年龄≥75岁）；S：收缩性心力衰竭；T：甲状腺疾病）的各个组成部分与COVID-19死亡风险因素相似，我们评估了C2HEST评分对心力衰竭（HF）患者的预测价值。材料与方法：本研究基于对2020年2月至2021年6月在弗罗茨瓦夫大学医院住院的2184例COVID-19患者的回顾性医学数据分析。测量的结果包括：住院死亡率、3个月和6个月全因死亡率、非致命性出院结局以及住院期间不良临床事件。结果：心力衰竭队列由255例患者组成，而1929例患者被纳入非心力衰竭队列。心力衰竭队列高风险C2HEST分层的住院、3个月和6个月死亡率最高，分别达到38.61%、53.96%和65.36%。在非心力衰竭队列中，高风险C2HEST分层的住院、3个月和6个月死亡率也最高，分别为26.39%、52.78%和65.0%。C2HEST评分增加1分使10%的心力衰竭患者的总死亡强度增加（风险比[HR]1.100，95%置信区间[CI]0.968−1.250，p = 0.143），而在非心力衰竭队列中，相同分值使总死亡强度增加62.3%（HR 1.623，95%CI 1.518−1.734，p < 0.0001）。结论：心力衰竭队列中的C2HEST评分在住院期间的死亡率和其他临床不良结局方面未显示出鉴别能力。非心力衰竭队列中的C2HEST评分在预测住院和6个月死亡率以及其他非致命临床结局（如心血管事件（心肌损伤、急性心力衰竭、心肌梗死、心源性休克）、肺炎、脓毒症和急性肾损伤）方面表现明显更好。
