Mortality prediction with CHA2DS2-VASc, CHA2DS2-VASc-HS and R2CHA2DS2-VASc score in patients hospitalized due to COVID-19.

OBJECTIVE: We aimed to test the efficiency of CHA2DS2-VASc, CHA2DS2-VASc-HS, R2CHA2DS2-VASc score systems on the prediction of mortality in the patients with COVID-19. PATIENTS AND METHODS: The data were collected from 508 hospitalized patients with COVID-19. Comorbidity features including coronary artery disease, peripheral arterial disease, congestive heart failure, hypertension, atrial fibrillation, diabetes mellitus, hyperlipidemia, smoking, chronic obstructive pulmonary disease, cerebrovascular event, cancer status, and renal disease were recorded. The patients were divided as surviving group (n=440) and non-survivors (n=68). RESULTS: The in-hospital mortality rate of the patients with COVID-19 was 13.4%. Factors found to be associated with mortality in univariate analysis were CHA2DS2-VASc, CHA2DS2-VASc-HS, R2CHA2DS2-VASc, cancer state, atrial fibrillation, hemoglobin, lymphocyte count, CRP, albumin and ferritin. Model 1 multivariate cox regression analysis revealed CHA2DS2-VASc, hemoglobin, CRP and ferritin levels to be independently associated with mortality. Factors that were found to be independently associated with in-hospital mortality in Model 2 analysis were CHA2DS2-VASc-HS, R2CHA2DS2-VASc, hemoglobin, CRP and ferritin whereas except hemoglobin in Model 3 analysis, the other variables had been the same. Predictive power of R2CHA2DS2-VASc was better than of both CHA2DS2-VASc (p=0.002) and CHA2DS2-VASc-HS (p=0.034) in determining the in-hospital mortality. Patients with higher R2CHA2DS2-VASc (> 3 points), CHA2DS2-VASc-HS (> 3 points) and CHA2DS2-VASc (> 2 points) scores exhibited the highest mortality rate in survival analysis by using Kaplan-Meier and long-rank tests. CONCLUSIONS: CHA2DS2-VASc, CHA2DS2-VASc-HS, and R2CHA2DS2-VASc were found to be independent predictors of mortality in hospitalized COVID-19 patients. The current study revealed that the predictive ability of R2CHA2DS2-VASc was better than the both of CHA2DS2-VASc and CHA2DS2-VASc-HS score.

Impact of acute myocardial injury on prognosis in patients with COVID-19.

OBJECTIVE: The primary objective of this study was to evaluate the frequency and impact of acute myocardial injury on prognosis in hospitalized COVID-19 patients. PATIENTS AND METHODS: This was a retrospective study that included consecutive hospitalized patients with COVID-19. Clinic-demographic characteristics, laboratory values, and high-sensitivity troponin I were extracted from the electronic database. Mortality and other clinical complications, including respiratory failure requiring invasive mechanical ventilation and acute kidney injury were recorded. Myocardial injury was defined as having a serum troponin I value >19.8 ng/mL. We performed Kaplan-Meier survival analysis and Cox regression to determine survival times and independent predictors of mortality. RESULTS: A total of 324 patients were included. Seventy-seven patients (23.8%) had acute myocardial injury. The primary outcome measure, namely death, occurred in 54.5% and 3.2% of the patients with and without myocardial injury, respectively. Notably, 75.3% of the patients with myocardial injury and 6.5% of the patients without myocardial injury developed ARDS. Overall, 50 out of 324 patients (15.4%) died during the study period. The mortality rate was 54.5% in patients with myocardial injury and 3.2% in patients without myocardial injury. Mean survival times were significantly different between the groups (15.1±0.9 days in patients with myocardial injury and 24.4±0.7 days in patients without myocardial injury, log-rank test p-value <0.001). CONCLUSIONS: The presence of chronic kidney disease and application of invasive mechanical ventilation were found to be independent predictors of in-hospital mortality. The presence of acute myocardial injury was common but not independently associated with mortality among hospitalized COVID-19 patients.

Impact of Serum 25(OH) Vitamin D Level on Mortality in Patients with COVID-19 in Turkey.

BACKGROUND: Because of the lack of sufficient data, we aimed to investigate the role of serum 25(OH) vitamin D level on COVID severity and related mortality. METHODS: This was a retrospective observational study. Data, including sociodemographic features, clinical characteristics, and laboratory data, and 25(OH) vitamin D levels were recorded for each study participant. Patients were stratified into different vitamin D groups; Normal (Serum 25(OH) vitamin D level >30 ng/mL), Vitamin D insufficiency (21-29 ng/mL), and deficiency (<20 ng/mL). The severity of COVID was classified according to the Chinese Clinical Guideline for classification of COVID-19 severity. Mortality data were determined for participants. Univariate and multivariate Logistic regression analysis was performed to determine independent predictors of in-hospital mortality. RESULTS: Overall, 149 COVID-19 patients (females 45.6%, mean age 63.5 ± 15.3 (range 24-90 years) years) were included. Forty-seven patients (31.5%) had moderate COVID-19, whereas 102 patients (68.5%) had severe-critical COVID-19. The mean 25(OH) vitamin D level was 15.2 ± 10.3 ng/mL. Thirty-four (22.8%) and 103 (69.1%) patients had vitamin D insufficiency and deficiency, respectively. Mean serum 25(OH) vitamin D level was significantly lower in patients with severe-critical COVID-19 compared with moderate COVID-19 (10.1 ± 6.2 vs. 26.3 ± 8.4 ng/mL, respectively, p<0.001). Vitamin D insufficiency was present in 93.1% of the patients with severe-critical COVID-19. Multivariate logistic regression analysis revealed that only lymphocyte count, white blood cell count, serum albumin and, 25(OH) vitamin D level were independent predictors of mortality. CONCLUSION: Serum 25(OH) vitamin D was independently associated with mortality in COVID-19 patients.