Mortality prediction using a modified R₂CHA₂DS₂-VASc score among hospitalized COVID-19 patients

The CHA₂DS₂-VASc score incorporates several comorbidities which have prognostic implications in COVID-19. We assessed whether a modified score (M-R₂CHA₂DS₂-VASc), which includes pre-admission kidney function and male sex, could be used to classify mortality risk among people hospitalized with COVID-19. This retrospective study included adults admitted for COVID-19 between March and December 2020. Pre-admission glomerular filtration rate (GFR) was calculated based on serum creatinine and used for scoring M-R₂CHA₂DS₂-VASc. Participants were categorized according to the M-R₂CHA₂DS₂-VASc categories as 0-1 (low), 2-3 (intermediate), or ≥ 4 (high), and according to initial COVID-19 severity score. The primary outcome was 30-day mortality rates. Secondary outcomes were mortality rates over time, and rates of mechanical ventilation, hemodynamic support, and renal replacement therapy. Eight hundred hospitalizations met the study criteria. Participants were 55% males, average age was 65.2 ± 17 years. There were similar proportions of subjects across the M-R₂CHA₂DS₂-VASc categories. 30-day mortality was higher in those in higher M-R₂CHA₂DS₂-VASc category and with severe or critical COVID-19 at admission. Subjects in the low, intermediate, and high M-R₂CHA₂DS₂-VASc categories had 30-day mortality rates of 4.7%, 17% and 31%, respectively (p < 0.001). Higher category was also associated with increased need for mechanical ventilation and renal replacement therapy. All-cause 90-day mortality remained significantly associated with M-R₂CHA₂DS₂-VASc. The M-R₂CHA₂DS₂-VASc score is associated with 30-day mortality rates among patients hospitalized with COVID-19, and adds predictive value when combined with initial COVID-19 severity.