Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Hospital Clinico San Carlos, Madrid, Spain.
Eur J Intern Med. 2024 Jun;124:108-114. doi: 10.1016/j.ejim.2024.03.002. Epub 2024 Mar 11.
Long-term consequences of COVID-19 are still partly known.
To derive a clinical score for risk prediction of long-term major cardiac adverse events (MACE) and all cause death in COVID-19 hospitalized patients.
2573 consecutive patients were enrolled in a multicenter, international registry (HOPE-2) from January 2020 to April 2021 and identified as the derivation cohort. Five hundred and twenty-six patients from the Cardio-Covid-Italy registry were considered as external validation cohort. A long-term prognostic risk score for MACE and all cause death was derived from a multivariable regression model.
Out of 2573 patients enrolled in the HOPE-2 registry, 1481 (58 %) were male, with mean age of 60±16 years. At long-term follow-up, the overall rate of patients affected by MACE and/or all cause death was 7.8 %. After multivariable regression analysis, independent predictors of MACE and all cause death were identified. The HOPE-2 prognostic score was therefore calculated by giving: 1-4 points for age class (<65 years, 65-74, 75-84, ≥85), 3 points for history of cardiovascular disease, 1 point for hypertension, 3 points for increased troponin serum levels at admission and 2 points for acute renal failure during hospitalization. Score accuracy at ROC curve analysis was 0.79 (0.74 at external validation). Stratification into 3 risk groups (<3, 3-6, >6 points) classified patients into low, intermediate and high risk. The observed MACE and all-cause death rates were 1.9 %, 9.4 % and 26.3 % for low- intermediate and high-risk patients, respectively (Log-rank test p < 0.01).
The HOPE-2 prognostic score may be useful for long-term risk stratification in patients with previous COVID-19 hospitalization. High-risk patients may require a strict follow-up.
COVID-19 的长期后果仍部分未知。
为预测 COVID-19 住院患者的长期主要心脏不良事件 (MACE) 和全因死亡的风险，建立一个临床评分。
2020 年 1 月至 2021 年 4 月，我们从一个多中心、国际注册中心（HOPE-2）中纳入了 2573 例连续患者，并将其作为推导队列。我们还纳入了来自 Cardio-Covid-Italy 注册中心的 526 例患者作为外部验证队列。我们从多变量回归模型中得出了用于预测 MACE 和全因死亡的长期预后风险评分。
在 HOPE-2 注册中心纳入的 2573 例患者中，1481 例（58%）为男性，平均年龄为 60±16 岁。在长期随访中，患者发生 MACE 和/或全因死亡的总比例为 7.8%。经过多变量回归分析，确定了 MACE 和全因死亡的独立预测因素。因此，HOPE-2 预后评分的计算方法为：年龄分组（<65 岁、65-74 岁、75-84 岁、≥85 岁）各计 1-4 分，心血管病史计 3 分，高血压计 1 分，入院时血清肌钙蛋白水平升高计 3 分，住院期间急性肾衰计 2 分。ROC 曲线分析的评分准确性为 0.79（外部验证为 0.74）。将患者分为 3 个风险组（<3、3-6、>6 分），低、中、高危患者的 MACE 和全因死亡率分别为 1.9%、9.4%和 26.3%（对数秩检验，p<0.01）。
HOPE-2 预后评分可用于预测 COVID-19 住院患者的长期风险分层。高危患者可能需要严格随访。
