Department of Nephrology, University Hospital of Split, Split, Croatia.
Department of Cardiology, University Hospital of Split, Spinčićeva 1, 21000, Split, Croatia.
Wien Klin Wochenschr. 2022 Dec;134(23-24):842-849. doi: 10.1007/s00508-022-02052-9. Epub 2022 Jul 7.
Kidney transplant recipients (KTR) are a group of patients with heterogeneous risks for adverse outcomes with COVID-19, but risk stratification tools in this patient group are lacking.
This retrospective observational, hypothesis-generating study included 49 hospitalized adult KTR patients with COVID-19 at the University Hospital of Split (August 2020 to October 2021) and evaluated the performance of novel risk score CROW-65 (age, Charlson Comorbidity Index [CCI] lactate dehydrogenase to white blood cell [LDH:WBC] ratio, and respiratory rate oxygenation [ROX index]). The primary outcome of the study was 30-day postdischarge all-cause mortality.
A total of 8 fatal events (16.3%) occurred during the study follow-up. When comparing CROW-65 by survival status, it was significantly increased in patients with fatal event (P < 0.001). Using the Cox proportional hazards regression analysis, the CROW-65 risk score showed statistically significant association with mortality (HR 1.11, 95% CI 1.01-1.23, P = 0.027), while receiving operator characteristics (ROC) showed significant discrimination of all-cause mortality with an AUC of 0.85 (95% CI 0.72-0.94, P < 0.001), and satisfactory calibration (χ 4.91, P = 0.555 and Harrell's C 0.835). Finally, survival Kaplan-Meier analysis confirmed significantly higher cumulative incidence of mortality with increasing risk score tertiles and curve separation after 13 days (P = 0.009).
A novel risk score CROW-65 showed significant association with all-cause mortality in KTR yielding important hypothesis-generating findings. Further powered studies should reassess the performance of CROW-65 risk score in this population, including predictability, calibration and discrimination.
肾移植受者（KTR）是一组 COVID-19 不良结局风险各异的患者，但该患者群体缺乏风险分层工具。
这项回顾性观察性、产生假说的研究纳入了 2020 年 8 月至 2021 年 10 月在斯普利特大学医院住院的 49 例 COVID-19 成年 KTR 患者，并评估了新型风险评分 CROW-65（年龄、Charlson 合并症指数[CCI]乳酸脱氢酶与白细胞[LDH：WBC]比值和呼吸频率氧合指数[ROX 指数]）的性能。该研究的主要结局是出院后 30 天的全因死亡率。
研究随访期间共发生 8 例死亡事件（16.3%）。比较生存状态下的 CROW-65，死亡事件患者的 CROW-65 明显升高（P<0.001）。使用 Cox 比例风险回归分析，CROW-65 风险评分与死亡率呈统计学显著关联（HR 1.11，95%CI 1.01-1.23，P=0.027），而接受者操作特征（ROC）显示全因死亡率具有显著的区分能力，AUC 为 0.85（95%CI 0.72-0.94，P<0.001），校准良好（χ 2=4.91，P=0.555 和 Harrell's C 0.835）。最后，生存 Kaplan-Meier 分析证实，随着风险评分三分位的增加，累积死亡率显著升高，且在 13 天后曲线分离（P=0.009）。
新型风险评分 CROW-65 与 KTR 的全因死亡率显著相关，得出了重要的假说产生结果。应进一步进行有足够效力的研究，重新评估 CROW-65 风险评分在该人群中的表现，包括预测性、校准和区分度。
