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

• Published in: Frontiers in medicine Vol. 10; p. 1259055
• Main Authors: Cimini, Christiane Corrêa Rodrigues, Delfino-Pereira, Polianna, Pires, Magda Carvalho, Ramos, Lucas Emanuel Ferreira, Gomes, Angélica Gomides dos Reis, Jorge, Alzira de Oliveira, Fagundes, Ariovaldo Leal, Garcia, Bárbara Machado, Pessoa, Bruno Porto, de Carvalho, Cíntia Alcantara, Ponce, Daniela, Rios, Danyelle Romana Alves, Anschau, Fernando, Vigil, Flavia Maria Borges, Bartolazzi, Frederico, Grizende, Genna Maira Santos, Vietta, Giovanna Grunewald, Goedert, Giulia Maria dos Santos, Nascimento, Guilherme Fagundes, Vianna, Heloisa Reniers, Vasconcelos, Isabela Muzzi, de Alvarenga, Joice Coutinho, Chatkin, José Miguel, Machado Rugolo, Juliana, Ruschel, Karen Brasil, Zandoná, Liege Barella, Menezes, Luanna Silva Monteiro, de Castro, Luís César, Souza, Maíra Dias, Carneiro, Marcelo, Bicalho, Maria Aparecida Camargos, Cunha, Maria Izabel Alcântara, Sacioto, Manuela Furtado, de Oliveira, Neimy Ramos, Andrade, Pedro Guido Soares, Lutkmeier, Raquel, Menezes, Rochele Mosmann, Ribeiro, Antonio Luiz Pinho, Marcolino, Milena Soriano
• Format: Journal Article
• Language: English
• Published: Frontiers Media S.A 16.11.2023
• Subjects: COVID-19; intensive care unit; invasive mechanical ventilation; prognosis; risk assessment
• ISSN: 2296-858X; 2296-858X
• DOI: 10.3389/fmed.2023.1259055

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 ABC 2 -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 ABC 2 -SPH score and comparison with other available scores, patients hospitalized from July 31, 2020, to March 31, 2022, were included; (ii) for ABC 2 -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 ABC 2 -SPH score. Comparisons between ABC 2 -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 ABC 2 -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 ABC 2 -SPH score recalibration, we observed improvements in calibration (slope = 1.135, intercept = 0.242) and overall performance (Brier score = 0.127). Conclusion The ABC 2 -SPHr risk score demonstrated a good performance to predict the need for mechanical ventilation in COVID-19 hospitalized patients under 80 years of age.