ABC(2)-SPH risk score for in-hospital mortality in COVID-19 patients: development, external validation and comparison with other available scores

Marcolino, Milena S.; Pires, Magda C.; Ramos, Lucas Emanuel F.; Silva, Rafael T.; Oliveira, Luana M.; Carvalho, Rafael L.R.; Mourato, Rodolfo Lucas S.; Sánchez-Montalvá, Adrián; Raventós, Berta; Anschau, Fernando; Chatkin, José Miguel; Nogueira, Matheus C.A.; Júnior, Milton H. Guimarães; Vietta, Giovanna G.; Duani, Helena; Ponce, Daniela; Ziegelmann, Patricia K.; Castro, Luís C.; Ruschel, Karen B.; Cimini, Christiane C.R.; Francisco, Saionara C.; Floriani, Maiara A.; Nascimento, Guilherme F.; Farace, Bárbara L.; Monteiro, Luanna S.; Souza-Silva, Maira V.R.; Sales, Thais L.S.; Martins, Karina Paula M.P.; Borges do Nascimento, Israel J.; Fereguetti, Tatiani O.; Ferrara, Daniel T.M.O.; Botoni, Fernando A.; Etges, Ana Paula B.S.; Boersma, Eric; Polanczyk, Carisi A.; Schwarzbold, Alexandre V.; Maurílio, Amanda O.; Scotton, Ana Luiza B.A.; Weber, André P.; Costa, André S.M.; Glaeser, Andressa B.; Madureira, Angélica Aparecida C.; Bhering, Angelinda R.; de Castro, Bruno Mateus; da Silva, Carla Thais C.A.; Ramos, Carolina M.; Gomes, Caroline D.; de Carvalho, Cíntia A.; Silveira, Daniel V.; Cezar, Edilson; Pereira, Elayne C.; Kroger, Emanuele Marianne S.; Vallt, Felipe B.; Lucas, Fernanda B.; Aranha, Fernando G.; Bartolazzi, Frederico; Crestani, Gabriela P.; Bastos, Gisele A.N.; Madeira, Glícia Cristina de C.; Noal, Helena Carolina; Vianna, Heloisa R.; Guimarães, Henrique C.; Gomes, Isabela M.; Romero, Israel M.; Batista, Joanna D.L.; de Alvarenga, Joice C.; Guimarães, Júlia D.S.S.; de Morais, Júlia D.P.; Rugolo, Juliana M.; Pontes, Karen Cristina J.R.; dos Santos, Kauane Aline M.; de Oliveira, Leonardo S.; Pinheiro, Lílian S.; Pacheco, Liliane S.; Sousa, Lucas de D.; Couto, Luciana S.F.; Kopittke, Luciane; de Moura, Luis Cesar S.; Santos, Luisa Elem A.; Cabral, Máderson A.S.; Souza, Maíra D.; Tofani, Marcela G.T.; Carneiro, Marcelo; Ferreira, Maria Angélica P.; Bicalho, Maria Aparecida C.; Lima, Maria Clara P.B.; Godoy, Mariana F.; Cardoso, Marilia M.A.; Figueiredo, Meire P.; Sampaio, Natália C.S.; Rangel, Natália L.; Crespo, Natália T.; de Oliveira, Neimy R.; Assaf, Pedro L.; Martelli, Petrônio José de L.; Almeida, Rafaela S.C.; Martins, Raphael C.; Lutkmeier, Raquel; Valacio, Reginaldo Aparecido; Finger, Renan G.; Cardoso, Ricardo B.; Pozza, Roberta; Campos, Roberta X.; Menezes, Rochele M.; de Abreu, Roger M.; Silva, Rufino de F.; Guimarães, Silvana M.M.; Araújo, Silvia F.; Pereira, Susany Anastácia; Oliveira, Talita F.; Kurtz, Tatiana; de Oliveira, Thainara C.; Araújo, Thaíza Simônia M.A.; Diniz, Thulio Henrique O.; dos Santos, Veridiana B.; Gomes, Virginia Mara R.; do Vale, Vitor Augusto L.; Ramires, Yuri C.

OBJECTIVES: The majority of available scores to assess mortality risk of coronavirus disease 19 (COVID-19) patients in the emergency department have high risk of bias. Therefore, our aim was to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients, and to compare this score with other existing ones. METHODS: Consecutive patients (≥18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March-July, 2020. The model was validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients. RESULTS: Median (25th-75th percentile) age of the model-derivation cohort was 60 (48-72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO(2)/FiO(2) ratio, platelet count and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829 to 0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833 to 0.885]) and Spanish (0.894 [95% CI 0.870 to 0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/). CONCLUSIONS: We designed and validated an easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation, for early stratification for in-hospital mortality risk of patients with COVID-19.