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Can the ADO Index Be Used as a Predictor of Mortality from COVID-19 in Patients with COPD?
Esra Ertan Yazar1, Gulsah Gunluoglu2, Burcu Arpinar Yigitbas1
1Department of Chest Diseases, Istanbul Medeniyet University, Medical Faculty, Istanbul, Turkey.
Insights
The ADO index, a marker for COPD patients, modestly predicts COVID-19 mortality. Lower eosinophil counts and higher ADO index scores indicate increased mortality risk in these patients.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Critical Care Medicine
Background:
- Chronic Obstructive Pulmonary Disease (COPD) patients face a high risk of mortality from COVID-19.
- Limited evidence exists on predictive factors for mortality in COVID-19 patients with COPD.
Purpose of the Study:
- To identify useful markers for predicting mortality in COVID-19 patients diagnosed with COPD.
- To investigate the predictive value of the ADO index in this patient population.
Main Methods:
- A national multicenter observational study (COPET) included 689 patients with spirometry-confirmed COPD.
- Patients were retrospectively analyzed for COVID-19 diagnosis and outcomes.
Main Results:
- 105 patients had PCR-positive COVID-19; 19 died.
- Higher Body Mass Index and ADO index, lower predicted FEV1 and eosinophil counts were observed in non-survivors.
- Each unit increase in ADO index (age, dyspnoea, airflow obstruction) increased mortality risk 2.12 times; each unit increase in eosinophil count decreased risk 1.007 times.
- An ADO score of 3.5 predicted mortality with 94% sensitivity.
Conclusions:
- The ADO index, assessed during stable COPD periods, offers modest predictive value for COVID-19 mortality.
- Further research is necessary to validate the ADO index for predicting mortality in COVID-19 and other respiratory viral infections among COPD patients.
Background:
Several studies have shown that the risk of mortality due to COVID-19 is high in patients with COPD. However, evidence on factors predicting mortality is limited.
Research Question:
Are there any useful markers to predict mortality in COVID-19 patients with COPD?.
Study Design And Methods:
A total of 689 patients were included in this study from the COPET study, a national multicenter observational study investigating COPD phenotypes consisting of patients who were followed up with a spirometry-confirmed COPD diagnosis. Patients were also retrospectively examined in terms of COVID-19 and their outcomes.
Results:
Among the study patients, 105 were diagnosed with PCR-positive COVID-19, and 19 of them died. Body mass index (p= 0.01) and ADO (age, dyspnoea, airflow obstruction) index (p= 0.01) were higher, whereas predicted FEV1 (p< 0.001) and eosinophil count (p= 0.003) were lower in patients who died of COVID-19. Each 0.755 unit increase in the ADO index increased the risk of death by 2.12 times, and each 0.007 unit increase in the eosinophil count decreased the risk of death by 1.007 times. The optimum cut-off ADO score of 3.5 was diagnostic with 94% sensitivity and 40% specificity in predicting mortality.
Interpretation:
Our study suggested that the ADO index recorded in the stable period in patients with COPD makes a modest contribution to the prediction of mortality due to COVID-19. Further studies are needed to validate the use of the ADO index in estimating mortality in both COVID-19 and other viral respiratory infections in patients with COPD.
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