Assessment of the ABC2-SPH risk score to predict invasive mechanical ventilation in COVID-19 patients and comparison to other scores.

Background: Predicting the need for invasive mechanical ventilation (IMV) is important for the allocation of human and technological resources, improvement of surveillance, and use of effective therapeutic measures. This study aimed (i) to assess whether the ABC2-SPH score is able to predict the receipt of IMV in COVID-19 patients; (ii) to compare its performance with other existing scores; (iii) to perform score recalibration, and to assess whether recalibration improved prediction. Methods: Retrospective observational cohort, which included adult laboratory-confirmed COVID-19 patients admitted in 32 hospitals, from 14 Brazilian cities. This study was conducted in two stages: (i) for the assessment of the ABC2-SPH score and comparison with other available scores, patients hospitalized from July 31, 2020, to March 31, 2022, were included; (ii) for ABC2-SPH score recalibration and also comparison with other existing scores, patients admitted from January 1, 2021, to March 31, 2022, were enrolled. For both steps, the area under the receiving operator characteristic score (AUROC) was calculated for all scores, while a calibration plot was assessed only for the ABC2-SPH score. Comparisons between ABC2-SPH and the other scores followed the Delong Test recommendations. Logistic recalibration methods were used to improve results and adapt to the studied sample. Results: Overall, 9,350 patients were included in the study, the median age was 58.5 (IQR 47.0-69.0) years old, and 45.4% were women. Of those, 33.5% were admitted to the ICU, 25.2% received IMV, and 17.8% died. The ABC2-SPH score showed a significantly greater discriminatory capacity, than the CURB-65, STSS, and SUM scores, with potentialized results when we consider only patients younger than 80 years old (AUROC 0.714 [95% CI 0.698-0.731]). Thus, after the ABC2-SPH score recalibration, we observed improvements in calibration (slope = 1.135, intercept = 0.242) and overall performance (Brier score = 0.127). Conclusion: The ABC2-SPHr risk score demonstrated a good performance to predict the need for mechanical ventilation in COVID-19 hospitalized patients under 80 years of age.

Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients.

BACKGROUND: Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. METHODS: This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). RESULTS: The median age of the model-derivation cohort was 59 (IQR 47-70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918-0.939) and validation (temporal AUROC 0.927, 95% CI 0.911-0.941; geographic AUROC 0.819, 95% CI 0.792-0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). CONCLUSIONS: The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation.

Reparo percutâneo de valva mitral pelo MitraClip: análise crítico-comparativa dos ensaios clínicos MITRA-FR E COAPT / Percutaneous mitral valve repair by MitraClip: critical-comparative analysis of MITRA-FR and COAPT clinical trials

Introdução: A valvuloplastia é indicada para o tratamento de regurgitação mitral grave, sendo a técnica transcateter uma opção à toracotomia. Testou-se o dispositivo MitraClip para reparo percutâneo da valva mitral em dois ensaios clínicos randomizados com resultados antagônicos: MITRA-FR e COAPT. Objetivo: Analisar as variáveis metodológicas apresentadas pelos ensaios. Método: Revisão crítico-comparativa entre MITRA-FR e COAPT. Resultados: COAPT apresentou taxa de sucesso de 98% e redução na taxa de hospitalização por IC. Já MITRA-FR não demonstrou redução da taxa de mortalidade ou da hospitalização não planejada por IC em um ano. Discussão: A seleção de participantes em COAPT mostrou-se mais criteriosa. Embora COAPT tenha utilizado maior número de clipes por operação, o desfecho primário nos dois ensaios foi semelhante. No COAPT, o acompanhamento medicamentoso foi estabelecido por um comitê, sendo relatado aumento expressivo do uso de betabloqueadores no grupo experimental. Ademais, interesses financeiros podem ter corroborado para os resultados encontrados no COAPT. Conclusão: Os resultados conflitantes de MITRA-FR e COAPT são explicados por diferenças metodológicas, mas o resultado positivo apresentado por COAPT possui maior risco de viés. [au]

Introduction: Valvuloplasty is indicated as treatment for severe mitral regurgitation and the transcatheter technique is an option to thoracotomy. The MitraClip device for percutaneous mitral valve repair has been tested in two randomized clinical trials with conflicting results: MITRA-FR and COAPT. Objective: Analyze the methodological varieties presented by the trials. Method: Critical-comparative review between MITRA-FR and COAPT. Results: COAPT presented a 98% success rate and a reduction of the hospitalization rate for heart failure. Contrarily, the MITRA-FR trial did not present any benefits in the reduction of the mortality rate or in the unplanned hospitalization for heart failure. Discussion: The selection of participants in COAPT was more rigorous. Although COAPT used a higher number of clips per operation, the primary outcome in both trials was similar. In COAPT, medication follow-up was established by a committee, with a significant increase in the use of beta-blockers in the experimental group being reported. Furthermore, financial interests may have corroborated the results found in COAPT. Conclusion: The conflicting results presented by MITRA-FR and COAPT are explained by methodological differences, but the positive result presented by COAPT had more risk of bias [au]