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Impact of CHA₂DS₂-VA score on COVID-19 disease-related outcomes
Gamze Yeter Arslan1, Metin Okşul2, Yusuf Ziya Şener3
1Department of Cardiology, Kepez State Hospital, Antalya, Turkey.
Insights
The simplified CHA₂DS₂-VA score effectively predicts 1-year mortality in Coronavirus disease (COVID-19) patients. This score also helps identify individuals at higher risk for intensive care unit (ICU) admission.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- The Coronavirus disease (COVID-19) pandemic has caused significant global mortality.
- The CHA₂DS₂-VASc score is established for predicting stroke risk in atrial fibrillation (AF).
- Previous research indicates the CHA₂DS₂-VASc score's utility in predicting mortality among COVID-19 patients.
Purpose of the Study:
- To evaluate the simplified CHA₂DS₂-VA score's efficacy in predicting mortality and intensive care unit (ICU) admission in COVID-19 patients.
- To assess the CHA₂DS₂-VA score as an independent predictor of adverse outcomes in COVID-19.
- To determine optimal cut-off values for the CHA₂DS₂-VA score for predicting mortality and ICU admission.
Main Methods:
- Retrospective analysis of 838 COVID-19 patients diagnosed between January 2021 and January 2022.
- Recorded baseline characteristics and CHA₂DS₂-VA scores.
- Employed logistic regression and ROC analysis to identify predictors of 1-year mortality and ICU admission.
Main Results:
- The CHA₂DS₂-VA score was found to be an independent predictor of 1-year mortality in COVID-19 patients (OR=1.63, p=0.029).
- A CHA₂DS₂-VA score cutoff of ≥3 predicted 1-year mortality with 75% sensitivity and 81% specificity (AUC:0.863).
- A CHA₂DS₂-VA score cutoff of ≥2 predicted ICU admission with 61% sensitivity and 74% specificity (AUC:0.725).
Conclusions:
- The CHA₂DS₂-VA score is a valuable independent predictor of 1-year mortality post-COVID-19.
- Defined cut-off values for the CHA₂DS₂-VA score can aid in identifying COVID-19 patients at increased risk for ICU admission and mortality.
- The predictive value of the CHA₂DS₂-VA score may be less pronounced in lower-risk patient populations.
Objective:
The Coronavirus disease (COVID-19) pandemic affected millions of people worldwide and caused hundreds of thousands of deaths. The CHA₂DS₂-VASc score is a scoring system used to determine the indication for anticoagulation in patients with atrial fibrillation (AF) and determines the risk of stroke. Previous studies have shown that it predicts mortality in COVID-19 patients well. New guidelines simplified the score as the CHA₂DS₂-VA score, which is free of sex factor. In this study, we planned to investigate the ability of this simplified score in predicting mortality and intensive care unit (ICU) admission in COVID-19 patients.
Materials And Methods:
All patients who were diagnosed with COVID-19 between January 2021 and January 2022 were screened, and patients with accessible data were enrolled. A total of 838 patients were included. The baseline characteristics of the patients and CHA₂DS₂-VA scores were recorded, and their relationship with poor outcomes was investigated. Mann-Whitney U and T-test were used for continuous variables, while logistic regression and ROC analysis were performed to identify predictors of 1-year mortality and ICU admission.
Results:
The mean age of the study population was 53.8 ± 18.5, and 53.6% of them (n = 449) were male. Intensive care unit (ICU) admission was present in 177 (21.1%) patients. 1-year mortality was present in 86 (10.3%) patients. Univariable regression analysis revealed that hypertension, diabetes mellitus, coronary artery disease, heart failure, atrial fibrillation, COPD, CHA2DS2-VA score, glomerular filtration rate, and albumin level were predictors of 1-year mortality. In multivariate regression analysis, only the CHA₂DS₂-VA score was predictive of 1-year mortality (OR = 1.63, 95% CI: 1.05-2.55; p = 0.029). Cut-off value of CHA2DS2-VA score for predicting 1-year mortality was found to be ≥ 3 (AUC:0.863, p < 0.001) with 75% sensitivity and 81% specificity. A CHA₂DS₂-VA score of ≥ 2 (AUC = 0.725, p < 0.001) constituted the cut-off value for intensive care admission with 61% sensitivity and 74% specificity.
Conclusions:
As a result of our study, we found that the CHA₂DS₂-VA score is an independent predictor of 1-year mortality following COVID-19 disease. Cut-off values of the CHA2DS2-VA score may help identify patients with an increased likelihood of ICU admission and 1-year mortality, although its predictive value may be limited in lower-risk populations.
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