Predicting In-Hospital Mortality in COVID-19 Older Patients with Specifically Developed Scores

Covino, M.; De Matteis, G.; Burzo, M. L.; Russo, A.; Forte, E.; Carnicelli, A.; Piccioni, A.; Simeoni, B.; Gasbarrini, A.; Franceschi, F.; Sandroni, C.; Abbate, V.; Acampora, N.; Addolorato, G.; Agostini, F.; Ainora, M. E.; Amato, E.; Andriollo, G.; Annicchiarico, B. E.; Antonelli, M.; Antonucci, G.; Armuzzi, A.; Barillaro, C.; Barone, F.; Bellantone, R. D. A.; Bellieni, A.; Benicchi, A.; Benvenuto, F.; Berloco, F.; Bernabei, R.; Bianchi, A.; Biasucci, L. M.; Bibbo, S.; Biscetti, F.; Bonadia, N.; Borghetti, A.; Bosco, G.; Bosello, S.; Bove, V.; Bramato, G.; Brandi, V.; Bruno, D.; Bungaro, M. C.; Buonomo, A.; Calabrese, A.; Cambieri, A.; Camma, G.; Candelli, M.; Capalbo, G.; Capaldi, L.; Capristo, E.; Carbone, L.; Cardone, S.; Carfi, A.; Caruso, C.; Casciaro, F. A.; Catalano, L.; Cauda, R.; Cecchini, A. L.; Cerrito, L.; Ciaburri, M.; Cianci, R.; Cicchinelli, S.; Francesca Ciciarello, A. C.; Cingolani, A.; Cipriani, M. C.; Coppola, G.; Corsello, A.; Costante, F.; D'Addio, S.; D'Alessandro, A.; D'Alfonso, M. E.; D'Angelo, E.; D'Aversa, F.; Damiano, F.; Cunzo, T. D.; Siena, M. D.; Vito, F. D.; Del Gatto, V.; Del Giacomo, P.; Del Zompo, F.; Della Polla, D. A.; Gialleonardo, L. D.; Giambenedetto, S. D.; Luca, R. D.; Maurizio, L. D.; Dusina, A.; Esperide, A.; Faliero, D.; Falsiroli, C.; Fantoni, M.; Fedele, A.; Feliciani, D.; Flex, A.; Franza, L.; Funaro, B.; Fuorlo, M.; Fusco, D.; Gabrielli, M.; Gaetani, E.; Gallo, A.; Gambassi, G.; Garcovich, M.; Gasparrini, I.; Gelli, S.; Giampietro, A.; Gigante, L.; Giuliano, G.; Giuliano, G.; Giupponi, B.; Gremese, E.; Guidone, C.; Iaconelli, A.; Iaquinta, A.; Impagnatiello, M.; Inchingolo, R.; Iorio, R.; Izzi, I. M.; Kadhim, C.; La Milia, D. I.; Landi, F.; Landi, G.; Landi, R.; Leo, M.; Liguori, A.; Liperoti, R.; Lizzio, M. M.; Lo Monaco, M. R.; Locantore, P.; Lombardi, F.; Lopetuso, L.; Loria, V.; Losito, A. R.; Macerola, N.; Maiuro, G.; Mancarella, F.; Mangiola, F.; Manno, A.; Marchesini, D.; Marrone, G.; Martis, I.; Martone, A. M.; Marzetti, E.; Matteo, M. V.; Miele, L.; Migneco, A.; Mignini, I.; Milani, A.; Milardi, D.; Montalto, M.; Monti, F.; Moschese, D.; Mothaenje, B. P. L.; Murace, C. A.; Murri, R.; Napoli, M.; Nardella, E.; Natalello, G.; Navarra, S. M.; Nesci, A.; Nicolazzi, M. A.; Nicoletti, A.; Nicoletti, T.; Nicolo, R.; Nicolotti, N.; Nista, E. C.; Nuzzo, E.; Ojetti, V.; Pagano, F. C.; Pais, C.; Papa, A.; Papparella, L. G.; Paratore, M.; Pecorini, G.; Perniola, S.; Pero, E.; Parrinello, G.; Petricca, L.; Petrucci, M.; Picarelli, C.; Pignataro, G.; Pignataro, R.; Pizzoferrato, M.; Pizzolante, F.; Pola, R.; Policola, C.; Pompili, M.; Pontecorvi, V.; Ponziani, F.; Popolla, V.; Porceddu, E.; Porfidia, A.; Privitera, G.; Pugliese, D.; Pulcini, G.; Racco, S.; Raffaelli, F.; Rapaccini, G. L.; Richeldi, L.; Rinninella, E.; Rocchi, S.; Romano, S.; Rosa, F.; Rossi, L.; Rossi, R.; Rossini, E.; Rota, E.; Rovedi, F.; Rumi, G.; Sabia, L.; Salerno, A.; Salini, S.; Salvatore, L.; Samori, D.; Sanguinetti, M.; Santarelli, L.; Santini, P.; Santoliquido, A.; Santopaolo, F.; Santoro, M. C.; Sardeo, F.; Sarnari, C.; Saviano, L.; Schepis, T.; Schiavello, F.; Scoppettuolo, G.; Sestito, L.; Settanni, C.; Siciliano, V.; Smargiassi, A.; Staiti, D.; Stella, L.; Taddei, E.; Talerico, R.; Tamburrini, E.; Tarli, C.; Tilli, P.; Torelli, E.; Tosato, M.; Tosoni, A.; Tricoli, L.; Tritto, M.; Tumbarello, M.; Tummolo, A. M.; Valletta, F.; Ventura, G.; Verardi, L.; Vetrone, L.; Vetrugno, G.; Visconti, E.; Zaccaria, R.; Zelano, L.; Dal Verme, L. Z.; Zuccala, G.

doi:10.1111/jgs.16956

Background/Objectives: Several scoring systems have been specifically developed for risk stratification in COVID-19 patients. Design: We compared, in a cohort of confirmed COVID-19 older patients, three specifically developed scores with a previously established early warning score. Main endpoint was all causes in-hospital death. Setting: This is a single-center, retrospective observational study, conducted in the Emergency Department (ED) of an urban teaching hospital, referral center for COVID-19. Participants: We reviewed the clinical records of the confirmed COVID-19 patients aged 60 years or more consecutively admitted to our ED over a 6-week period (March 1st to April 15th, 2020). A total of 210 patients, aged between 60 and 98 years were included in the study cohort. Measurements: International Severe Acute Respiratory Infection Consortium Clinical Characterization Protocol-Coronavirus Clinical Characterization Consortium (ISARIC-4C) score, COVID-GRAM Critical Illness Risk Score (COVID-GRAM), quick COVID-19 Severity Index (qCSI), National Early Warning Score (NEWS). Results: Median age was 74 (67–82) and 133 (63.3%) were males. Globally, 42 patients (20.0%) deceased. All the score evaluated showed a fairly good predictive value with respect to in-hospital death. The ISARIC-4C score had the highest area under ROC curve (AUROC) 0.799 (0.738–0.851), followed by the COVID-GRAM 0.785 (0.723–0.838), NEWS 0.764 (0.700–0.819), and qCSI 0.749 (0.685–0.806). However, these differences were not statistical significant. Conclusion: Among the evaluated scores, the ISARIC-4C and the COVID-GRAM, calculated at ED admission, had the best performance, although the qCSI had similar efficacy by evaluating only three items. However, the NEWS, already widely validated in clinical practice, had a similar performance and could be appropriate for older patients with COVID-19.