Utility of Age-adjusted Charlson Comorbidity Index as a Predictor of Need for Invasive Mechanical Ventilation, Length of Hospital Stay, and Survival in COVID-19 Patients

Shanbhag, V.; Arjun, N. R.; Chaudhuri, S.; Pandey, A. K.

Background: Multiple parameters may be used to prognosticate coronavirus disease 2019 (COVID-19) patients, which are often expensivelaboratory or radiological investigations. We evaluated the utility of age-adjusted Charlson comorbidity index (CCI) as a predictor of outcomein COVID-19 patients treated with remdesivir. Materials and methods: This was a single-center, retrospective study on 126 COVID-19 patients treated with remdesivir. The age-adjusted CCI, length of hospital stay (LOS), need for invasive mechanical ventilation (IMV), and survival were recorded. Results: The mean and standard deviation (SD) of age-adjusted CCI were 3.37 and 2.186, respectively. Eighty-six patients (70.5%) had ageadjusted CCI <= 4, and 36 (29.5%) had age-adjusted CCI >4. Among patients with age-adjusted CCI <= 4, 20 (23.3%) required IMV, whereas in thosewith age-adjusted CCI >4, 19 (52.8%) required IMV (p <0.05, Pearson's chi-square test). In those with age-adjusted CCI <= 4, the mortality was18.6%, whereas it was 41.7% in patients with age-adjusted CCI >4 (p <0.05, Pearson's chi-square test). The receiver operating curve (ROC) ofage-adjusted CCI for predicting the mortality had an area under the curve (AUC) of 0.709, p = 0.001, and sensitivity 68%, specificity 62%, and95% confidence interval (CI) [0.608, 0.810], for a cutoff score >4. The ROC for age-adjusted CCI for predicting the need for IMV had an AUC of0.696, p = 0.001, and sensitivity 67%, specificity 63%, and 95% CI [0.594, 0.797], for a cutoff score >4. ROC for age-adjusted CCI as a predictorof prolonged LOS (>= 14 days) was insignificant. Conclusion: In COVID-19 patients, the age-adjusted CCI is an independent predictor of the need for IMV (score >4) and mortality (score >4) but is not useful to predict LOS (CTRI/2020/11/029266).