The COVID-19 Assessment for Survival at Admission (CASA) Index: A 12 Months Observational Study

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Biostatistics

Background:

• Coronavirus disease 2019 (COVID-19) can rapidly progress to critical illness, necessitating effective patient risk stratification.
• Current methods for identifying COVID-19 patients at high risk of mortality are not sufficiently defined.
• Accurate risk assessment is crucial for appropriate resource allocation and patient management in COVID-19.

Purpose of the Study:

• To develop and validate a pragmatic mortality risk index for hospitalized COVID-19 patients.
• To establish a tool for stratifying patients to the appropriate intensity of care.
• To improve the identification of individuals at high risk of in-hospital mortality from COVID-19.

Main Methods:

• An observational, longitudinal study conducted over 12 months (March 2020 - March 2021).
• Inclusion criteria: COVID-19 patients aged 18 years or older admitted to the hospital.
• Development and validation of the Covid-19 Assessment for Survival at Admission (CASA) index using seven readily available variables.

Main Results:

• The study included 244 patients with a significant in-hospital mortality rate of 29.9%.
• The CASA index, incorporating respiratory rate, troponin, albumin, CKD-EPI, white blood cell count, D-dimer, and PaO2/FiO2, demonstrated high mortality discrimination (AUC = 0.91).
• CASA outperformed SOFA, age, and the 4C mortality score in predicting mortality, with a negative predictive value of 99.16%.

Conclusions:

• The CASA index is a rapid and accessible tool for stratifying COVID-19 patient mortality risk.
• This index can guide clinical decisions regarding the intensity of care required.
• Utilizing the CASA index may help minimize hospital admissions for patients identified as high-risk for mortality.