Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Intern Emerg Med. 2022 Sep;17(6):1711-1717. doi: 10.1007/s11739-022-02993-z. Epub 2022 Jun 25.
The CHADS-VASc score incorporates several comorbidities which have prognostic implications in COVID-19. We assessed whether a modified score (M-RCHADS-VASc), which includes pre-admission kidney function and male sex, could be used to classify mortality risk among people hospitalized with COVID-19. This retrospective study included adults admitted for COVID-19 between March and December 2020. Pre-admission glomerular filtration rate (GFR) was calculated based on serum creatinine and used for scoring M-RCHADS-VASc. Participants were categorized according to the M-RCHADS-VASc categories as 0-1 (low), 2-3 (intermediate), or ≥ 4 (high), and according to initial COVID-19 severity score. The primary outcome was 30-day mortality rates. Secondary outcomes were mortality rates over time, and rates of mechanical ventilation, hemodynamic support, and renal replacement therapy. Eight hundred hospitalizations met the study criteria. Participants were 55% males, average age was 65.2 ± 17 years. There were similar proportions of subjects across the M-RCHADS-VASc categories. 30-day mortality was higher in those in higher M-RCHADS-VASc category and with severe or critical COVID-19 at admission. Subjects in the low, intermediate, and high M-RCHADS-VASc categories had 30-day mortality rates of 4.7%, 17% and 31%, respectively (p < 0.001). Higher category was also associated with increased need for mechanical ventilation and renal replacement therapy. All-cause 90-day mortality remained significantly associated with M-RCHADS-VASc. The M-RCHADS-VASc score is associated with 30-day mortality rates among patients hospitalized with COVID-19, and adds predictive value when combined with initial COVID-19 severity.
CHADS-VASc 评分纳入了一些与 COVID-19 预后相关的合并症。我们评估了是否可以使用改良评分（M-RCHADS-VASc），该评分纳入了入院前肾功能和男性，来对因 COVID-19 住院的患者进行死亡率风险分类。这项回顾性研究纳入了 2020 年 3 月至 12 月期间因 COVID-19 入院的成年人。基于血清肌酐计算入院前肾小球滤过率（GFR），并用于 M-RCHADS-VASc 评分。根据 M-RCHADS-VASc 类别（0-1[低]、2-3[中]或≥4[高]）和初始 COVID-19 严重程度评分对患者进行分类。主要结局是 30 天死亡率。次要结局是随时间推移的死亡率，以及机械通气、血流动力学支持和肾脏替代治疗的发生率。符合研究标准的 800 例住院患者中，男性占 55%，平均年龄为 65.2±17 岁。M-RCHADS-VASc 各分类中患者比例相似。M-RCHADS-VASc 分类较高且入院时 COVID-19 严重程度为重度或危重度的患者 30 天死亡率更高。低、中、高 M-RCHADS-VASc 分类患者的 30 天死亡率分别为 4.7%、17%和 31%（p<0.001）。分类较高还与机械通气和肾脏替代治疗的需求增加相关。全因 90 天死亡率仍与 M-RCHADS-VASc 显著相关。M-RCHADS-VASc 评分与 COVID-19 住院患者的 30 天死亡率相关，与初始 COVID-19 严重程度相结合时可增加预测价值。
