COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Clinical Prediction Guide Gunduz R, Yildiz BS, Ozdemir IH, et al. CHA2DS2-VASc score and modified CHA2DS2-VASc score can predict mortality and intensive care unit hospitalization in COVID-19 patients. J Thromb Thrombolysis. 2021 Mar 17. pii: 10.1007/s11239-021-02427-1. doi: 10.1007/s11239-021-02427-1.
Abstract

In this study, we investigated whether the CHA2DS2-VASc score could be used to estimate the need for hospitalization in the intensive care unit (ICU), the length of stay in the ICU, and mortality in patients with COVID-19. Patients admitted to Merkezefendi State Hospital because of COVID-19 diagnosis confirmed by RNA detection of virus by using polymerase chain reaction between March 24, 2020 and July 6, 2020, were screened retrospectively. The CHA2DS2-VASc and modified CHA2DS2-VASc score of all patients was calculated. Also, we received all patients' complete biochemical markers including D-dimer, Troponin I, and c-reactive protein on admission. We enrolled 1000 patients; 791 were admitted to the general medical service and 209 to the ICU; 82 of these 209 patients died. The ROC curves of the CHA2DS2-VASc and M-CHA2DS2-VASc scores were analyzed. The cut-off values of these scores for predicting mortality were = 3 (2 or under and 3). The CHA2DS2-VASc and M-CHA2DS2-VASc scores had an area under the curve value of 0.89 on the ROC. The sensitivity and specificity of the CHA2DS2-VASc scores were 81.7% and 83.8%, respectively; the sensitivity and specificity of the M-CHA2DS2-VASc scores were 85.3% and 84.1%, respectively. Multivariate logistic regression analysis showed that CHA2DS2-VASc, Troponin I, D-Dimer, and CRP were independent predictors of mortality in COVID-19 patients. Using a simple and easily available scoring system, CHA2DS2-VASc and M-CHA2DS2-VASc scores can be assessed in patients diagnosed with COVID-19. These scores can predict mortality and the need for ICU hospitalization in these patients.

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

Infectious Disease rater

The retrospective study or “routine data base study” is not so valid for calculating the cut-off value and sensitivity and specificity of variables. For this purpose, we need to gather new data in diagnostic study rules.

Infectious Disease rater

Interesting use of the risk score for COVID-19 morbidity and mortality, though it brings up that this set of risks is likely predictive for faring poorly from a number of acute illnesses. This will be useful when we are better able to understand what interventions to add and when, for patients predicted to need the ICU due to COVID-19 disease.

Intensivist/Critical Care rater

This a retrospective study in covid-19 patients. Some RCTs just published have shown the futility of anticoagulation in these patients. This is only recommended in case of TVE.

Respirology/Pulmonology rater

As a pulmonologist interested in pneumonia, I find CHA2DS2-VASc score and modified CHA2DS2-VASc score are not well-known predictors for ICU admission and mortality for COVID-19. D-Dimer alone may be more acceptable for evaluation of endothelial dysfunction and thrombosis in patients with severe COVID-19.