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Cimini CCR, Delfino-Pereira P, Pires MC, Ramos LEF, Gomes AGDR, Jorge ADO, Fagundes AL, Garcia BM, Pessoa BP, de Carvalho CA, Ponce D, Rios DRA, Anschau F, Vigil FMB, Bartolazzi F, Grizende GMS, Vietta GG, Goedert GMDS, Nascimento GF, Vianna HR, Vasconcelos IM, de Alvarenga JC, Chatkin JM, Machado Rugolo J, Ruschel KB, Zandoná LB, Menezes LSM, de Castro LC, Souza MD, Carneiro M, Bicalho MAC, Cunha MIA, Sacioto MF, de Oliveira NR, Andrade PGS, Lutkmeier R, Menezes RM, Ribeiro ALP, Marcolino MS. Assessment of the ABC 2-SPH risk score to predict invasive mechanical ventilation in COVID-19 patients and comparison to other scores. Front Med (Lausanne) 2023; 10:1259055. [PMID: 38046414 PMCID: PMC10690599 DOI: 10.3389/fmed.2023.1259055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/25/2023] [Indexed: 12/05/2023] Open
Abstract
Background Predicting the need for invasive mechanical ventilation (IMV) is important for the allocation of human and technological resources, improvement of surveillance, and use of effective therapeutic measures. This study aimed (i) to assess whether the ABC2-SPH score is able to predict the receipt of IMV in COVID-19 patients; (ii) to compare its performance with other existing scores; (iii) to perform score recalibration, and to assess whether recalibration improved prediction. Methods Retrospective observational cohort, which included adult laboratory-confirmed COVID-19 patients admitted in 32 hospitals, from 14 Brazilian cities. This study was conducted in two stages: (i) for the assessment of the ABC2-SPH score and comparison with other available scores, patients hospitalized from July 31, 2020, to March 31, 2022, were included; (ii) for ABC2-SPH score recalibration and also comparison with other existing scores, patients admitted from January 1, 2021, to March 31, 2022, were enrolled. For both steps, the area under the receiving operator characteristic score (AUROC) was calculated for all scores, while a calibration plot was assessed only for the ABC2-SPH score. Comparisons between ABC2-SPH and the other scores followed the Delong Test recommendations. Logistic recalibration methods were used to improve results and adapt to the studied sample. Results Overall, 9,350 patients were included in the study, the median age was 58.5 (IQR 47.0-69.0) years old, and 45.4% were women. Of those, 33.5% were admitted to the ICU, 25.2% received IMV, and 17.8% died. The ABC2-SPH score showed a significantly greater discriminatory capacity, than the CURB-65, STSS, and SUM scores, with potentialized results when we consider only patients younger than 80 years old (AUROC 0.714 [95% CI 0.698-0.731]). Thus, after the ABC2-SPH score recalibration, we observed improvements in calibration (slope = 1.135, intercept = 0.242) and overall performance (Brier score = 0.127). Conclusion The ABC2-SPHr risk score demonstrated a good performance to predict the need for mechanical ventilation in COVID-19 hospitalized patients under 80 years of age.
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Affiliation(s)
- Christiane Corrêa Rodrigues Cimini
- Hospital Santa Rosália, Teófilo Otoni, Minas Gerais, Brazil
- Mucuri's Medical School and Telehealth Center, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Teófilo Otoni, Minas Gerais, Brazil
| | - Polianna Delfino-Pereira
- Universidade Federal de Minas Gerais and Institute for Health and Technology Assessment (IATS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Magda Carvalho Pires
- Department of Statistics, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | | | | | | | | | - Daniela Ponce
- Hospital das Clínicas da Faculdade de Medicina de Botucatu, Av. Prof. Mário Rubens Guimarães Montenegro, UNESP, Botucatu, São Paulo, Brazil
| | | | - Fernando Anschau
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | | | | | | | | | - Isabela Muzzi Vasconcelos
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - José Miguel Chatkin
- Hospital São Lucas PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
- Pontifica Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliana Machado Rugolo
- Hospital das Clínicas da Faculdade de Medicina de Botucatu, Av. Prof. Mário Rubens Guimarães Montenegro, UNESP, Botucatu, São Paulo, Brazil
| | - Karen Brasil Ruschel
- Institute for Health Technology Assessment (IATS/CNPq), Porto Alegre, Rio Grande do Sul, Brazil
- Hospital Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital Universitário de Canoas, Canoas, Rio Grande do Sul, Brazil
| | | | | | | | - Maíra Dias Souza
- Hospital Metropolitano Odilon Behrens, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo Carneiro
- Hospital Santa Cruz, Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Maria Aparecida Camargos Bicalho
- Hospital João XXIII, Belo Horizonte, Minas Gerais, Brazil
- Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Cidade Administrativa de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Pedro Guido Soares Andrade
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Raquel Lutkmeier
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Antonio Luiz Pinho Ribeiro
- Cardiology Service, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Institute for Health Technology Assessment (IATS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Milena Soriano Marcolino
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Institute for Health Technology Assessment (IATS/CNPq), Porto Alegre, Rio Grande do Sul, Brazil
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