Generation and validation of in-hospital mortality prediction score in COVID-19 patients: Alba-score.

Alfaro-Martínez, José-Joaquín; Calbo Mayo, Juan; Molina Cifuentes, María; Abizanda Soler, Pedro; Guillén Martínez, Sergio; Rodríguez Marín, Yulema; Esteban Sirvent, Alejandro; Nuñez Ares, Ana; Alcaraz Barcelona, Marina; Paterna Mellinas, Gema; Cuesta Vizcaíno, Encarna; Martínez Alfaro, Elisa; Solís García Del Pozo, Julián

BACKGROUND COVID-19 has a wide range of symptoms reported, which may vary from very mild cases (even asymptomatic) to deadly infections. Identifying high mortality risk individuals infected with the SARS-CoV-2 virus through a prediction instrument that uses simple clinical and analytical parameters at admission can help clinicians to focus on treatment efforts in this group of patients. METHODS Data was obtained retrospectively from the electronic medical record of all COVID-19 patients hospitalized in the Albacete University Hospital Complex until July 2020. Patients were split into two: a generating and a validating cohort. Clinical, demographical, and laboratory variables were included. A multivariate logistic regression model was used to select variables associated with in-hospital mortality in the generating cohort. A numerical and subsequently a categorical score according to mortality was constructed (A.-mortality from 0 to 5%; B.-from 5 to 15%; C.-from 15 to 30%; D.-from 30 to 50%; E.-greater than 50%). These scores were validated with the validation cohort. RESULTS Variables independently related to mortality during hospitalization were age, diabetes mellitus, confusion, SaFiO2, heart rate, and LDH at admission. The numerical score defined ranges from 0 to 13 points. Scores included are: age ≥71 years (3 points), diabetes mellitus (1 point), confusion (2 points), onco-hematologic disease (1 point), SaFiO2 ≤ 419 (3 points), heart rate ≥100 bpm (1point), and LDH ≥390 IU/L (2 points). The area under the curve (AUC) for the numerical and categorical scores from the generating cohort were 0.8625 and 0.848, respectively. In the validating cohort, AUCs were 0.8505 for the numerical score and 0.8313 for the categorical score. CONCLUSIONS . Data analysis found a correlation between clinical admission parameters and in-hospital mortality for COVID-19 patients. This correlation is used to develop a model to assist physicians in the emergency department in the COVID-19 treatment decision-making process.