COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Clinical Prediction Guide Bernabeu-Wittel M, Ternero-Vega JE, Diaz-Jimenez P, et al. Death risk stratification in elderly patients with covid-19. A comparative cohort study in nursing homes outbreaks. Arch Gerontol Geriatr. 2020 Aug 25;91:104240. doi: 10.1016/j.archger.2020.104240.
Abstract

Elderly people are more severely affected by COVID-19. Nevertheless scarce information about specific prognostic scores for this population is available. The main objective was to compare the accuracy of recently developed COVID-19 prognostic scores to that of CURB-65, Charlson and PROFUND indices in a cohort of 272 elderly patients from four nursing homes, affected by COVID-19. Accuracy was measured by calibration (calibration curves and Hosmer-Lemeshov (H-L) test), and discriminative power (area under the receiver operation curve (AUC-ROC). Negative and positive predictive values (NPV and PPV) were also obtained. Overall mortality rate was 22.4 %. Only ACP and Shi et al. out of 10 specific COVID-19 indices could be assessed. All indices but CURB-65 showed a good calibration by H-L test, whilst PROFUND, ACP and CURB-65 showed best results in calibration curves. Only CURB-65 (AUC-ROC?=?0.81 [0.75-0.87])) and PROFUND (AUC-ROC?=?0.67 [0.6-0.75])) showed good discrimination power. The highest NPV was obtained by CURB-65 (95 % [90-98%]), PROFUND (93 % [77-98%]), and their combination (100 % [82-100%]); whereas CURB-65 (74 % [51-88%]), and its combination with PROFUND (80 % [50-94%]) showed highest PPV. PROFUND and CURB-65 indices showed the highest accuracy in predicting death-risk of elderly patients affected by COVID-19, whereas Charlson and recent developed COVID-19 specific tools lacked it, or were not available to assess. A comprehensive clinical stratification on two-level basis (basal death risk due to chronic conditions by PROFUND index, plus current death risk due to COVID-19 by CURB-65), could be an appropriate approach.

Ratings
Discipline / Specialty Area Score
Infectious Disease
Hospital Doctor/Hospitalists
Internal Medicine
Geriatrics
Respirology/Pulmonology
Intensivist/Critical Care
Comments from MORE raters

Geriatrics rater

The manuscript was well written and demonstrated that CURB-65 tool performed better than many other clinical prediction models for elderly patients with COVID-19.

Hospital Doctor/Hospitalists rater

The article was hard to read because it required a solid background in statistics. However, Figure 3 was totally worth it.

Infectious Disease rater

As a physician treating COVID patients, the article provides good insights in focused care by risk stratification.

Internal Medicine rater

The authors have shown that the combination of PROFUND and CURB-65 indices had the highest accuracy in predicting death-risk of elderly patients. Contrarily, Charlson index and recent developed COVID-19 specific tools lacked the accuracy.