DEATH RISK STRATIFICATION IN ELDERLY PATIENTS WITH COVID-19. A COMPARATIVE COHORT STUDY IN NURSING HOMES OUTBREAKS

Bernabeu-Wittel, M.; Ternero-Vega, J.E.; Díaz-Jiménez, P.; Conde-Guzmán, C.; Nieto-Martín, M.D.; Moreno-Gaviño, L.; Delgado-Cuesta, J.; Rincón-Gómez, M.; Giménez-Miranda, L.; Navarro-Amuedo, M.D.; Muñoz-García, M.M.; Calzón-Fernández, S.; Ollero-Baturone, M.

Elderly people are more severely affected by COVID-19. Nevertheless scarce information about specific prognostic scores for this population is available. The main objective was to compare the accuracy of recently developed COVID-19 prognostic scores to that of CURB-65, Charlson and PROFUND indices in a cohort of 272 elderly patients from four nursing homes, affected by COVID-19. Accuracy was measured by calibration (calibration curves and Hosmer-Lemeshov (H-L) test), and discriminative power (area under the receiver operation curve (AUC-ROC). Negative and positive predictive values (NPV and PPV) were also obtained. Overall mortality rate was 22.4%. Only ACP and Shi et al. out of 10 specific COVID-19 indices could be assessed. All indices but CURB-65 showed a good calibration by H-L test, whilst PROFUND, ACP and CURB-65 showed best results in calibration curves. Only CURB-65 (AUC-ROC = 0.81 [0.75 to 0.87])) and PROFUND (AUC-ROC = 0.67 [0.6 to 0.75])) showed good discrimination power. The highest NPV was obtained by CURB-65 (95% [90 to 98%]), PROFUND (93% [77to 98%]), and their combination (100% [82 to 100%]); whereas CURB-65 (74% [51 to 88%]), and its combination with PROFUND (80% [50 to 94%]) showed highest PPV. PROFUND and CURB-65 indices showed the highest accuracy in predicting death-risk of elderly patients affected by COVID-19, whereas Charlson and recent developed COVID-19 specific tools lacked it, or were not available to assess. A comprehensive clinical stratification on two-level basis (basal death risk due to chronic conditions by PROFUND index, plus current death risk due to COVID-19 by CURB-65), could be an appropriate approach.