Derivation and validation of a new predictive score for mortality from COVID-19 at high altitude

DOI:  https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.12229

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Published: Feb 23, 2024
Issue: Vol. 22 No. 1 (2024): Revista Ciencias de la Salud
Section Clinical or Experimental Research


Keywords: covid-19 , community-acquired pneumonia , early warning score , news covid-19 , neumonía adquirida en la comunidad , puntaje de alerta temprana , news covid-19 , pneumonia adquirida na comunidade , pontuação de alerta precoce , news

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Authors

  Walter Calderón Gerstein a:1:{s:5:"es_ES";s:23:"Universidad Continental";}
Jorge López-Peña
Gabriela Torres-Samaniego
Jorge Espinoza-Zavaleta https://orcid.org/0000-0002-1857-7719
Yalila Núñez-Martínez
Anibal Urriola-Gonzales
Mirella Calderón-Anyosa
Raúl Macha-Ramírez
Lizet Huayllani-Flores
Roy Cabrera-Osorio
Abstract

Objective: To develop a mortality predictive score for patients with COVID-19. Materials and Methods: Retrospective, analytical, observational and cross-sectional study, carried out in two phases. 620 medical records were reviewed, with a derivation cohort of 320 patients and a validation cohort of 300 patients. The variables were analyzed with ANOVA, Pearson's chi square test and multivariate analysis with binary regression, determining sensitivity, specificity, negative and positive predictive value. The scores were compared using ROC curves with the NEWS and HEWS scores. Results: The two scores obtained included values ​​for: age, lymphocyte count, SatO2/FiO2, leukocytes, platelets, absence of symptoms, arterial hypertension, DILD and DHL. The area under the curve (AUC) was 0.838 for the DHL score, with 100% mortality for 7.75 points or more, and an AUC of 0.826 for the first score. In the validation cohort, the AUC for the first score was 0.831 and for the DHL score it was 0.855. The HEWS score obtained an AUC of 0.451 and the NEWS an AUC of 0.396. Conclusions: Two clinical tools were developed to predict mortality in patients with COVID-19, with high power of discrimination, superior to the British HEWS and NEWS scores.


Keywords: COVID-19, community-acquired pneumonia, early warning score, NEWS

How to Cite
Calderón Gerstein, W., López-Peña, J. ., Torres-Samaniego, G. ., Espinoza-Zavaleta, J., Núñez-Martínez, Y., Urriola-Gonzales, A. ., … Cabrera-Osorio, R. (2024). Derivation and validation of a new predictive score for mortality from COVID-19 at high altitude. Revista Ciencias De La Salud, 22(1), 1–24. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.12229
References

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with covid-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-62. https://doi.org/10.1016/S0140-6736(20)30566-3

COVID-19: cronología de la actuación de la OMS [internet]. [Citado 6 de julio de 2021]. Disponible en: https://www.who.int/es/news/item/27-04-2020-who-timeline--- covid-19

Parasher A. COVID-19: current understanding of its pathophysiology, clinical presentation and treatment. Postgrad Med J. 2021 May;97(1147):312-20. https://doi.org/10.1136/postgradmedj-2020-138577

Ejaz H, Alsrhani A, Zafar A, Javed H, Junaid K, Abdalla AE, et al. COVID-19 and comorbidities: Deleterious impact on infected patients. J Infect Public Health. 2020;13(12):1833-9. https://doi.org/10.1016/j.jiph.2020.07.014

Myrstad M, Ihle-Hansen H, Tveita AA, Andersen EL, Nygård S, Tveit A, et al. National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from covid-19 - a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2020 Jul 13;28(1):66. https://doi.org/10.1186/s13049-020-00764-3

Estimation of excess mortality due to covid-19 [internet]. Institute for Health Metrics and Evaluation. 2021 [citado 6 de julio de 2021]. Disponible en: http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid- 19-and-scalars-reported-covid-19-deaths

Tasa de mortalidad y de readmisión entre pacientes con covid-19 después del alta de un entorno de cuidados agudos con oxígeno suplementario. SAPUE [internet]. [Citado 6 de julio de 2021]. Disponible en: https://sapue.com.ar/tasa-de- mortalidad-y-de-readmision-entre-pacientes-con-covid-19-despues-del-alta-de-un- entorno-de-cuidados-agudos-con-oxigeno-suplementario/

Sirvent JM, Baro A, Morales M, Sebastian P, Saiz X. Biomarcadores predictivos de mortalidad en pacientes críticos con covid-19. Med Intensiva [internet]. [Citado 6 de julio de 2021]; Disponible en: http://www.medintensiva.org/es-biomarcadores- predictivos-mortalidad-pacientes-criticos-avance-S021056912030334X

López MGF, Tarazona AS, Cruz-Vargas JADL, López MGF, Tarazona AS, Cruz- Vargas JADL. Distribución regional de mortalidad por covid-19 en Perú. Rev Fac Med Humana. 2021 abr;21(2):326-34.

Knight SR, Ho A, Pius R, Buchan I, Carson G, Drake TM, et al. Risk stratification of patients admitted to hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: development and validation of the 4C Mortality Score. BMJ. 9 de septiembre de 2020;m3339.

Wynants L, Van Calster B, Collins GS, Riley RD, Heinze G, Schuit E, et al. Prediction models for diagnosis and prognosis of covid-19: systematic review and critical appraisal. BMJ. 2020 abr 7;369:m1328. https://doi.org/10.1136/bmj.m1328

Altschul DJ, Unda SR, Benton J, de la Garza Ramos R, Cezayirli P, Mehler M, et al. A novel severity score to predict inpatient mortality in covid-19 patients. Sci Rep. 2020 Oct 7;10(1):16726. https://doi.org/10.1038/s41598-020-73962-9

Xiang G, Xie L, Chen Z, Hao S, Fu C, Wu Q, et al. Clinical risk factors for mortality of hospitalized patients with covid-19: systematic review and meta-analysis. Ann Palliat Med. 2021 Mar;10(3):2723-2735. https://doi.org/10.21037/apm-20-1278

Chen Y, Zhou X, Yan H, et al. CANPT Score: a tool to predict severe covid-19 on admission. Front Med (Lausanne). 2021;8:608107. https://doi.org/10.3389/fmed.2021.608107

Su Y, Ju MJ, Xie RC, et al. Prognostic accuracy of early warning scores for clinical deterioration in patients with covid-19. Front Med (Lausanne). 2021;7:624255. https://doi.org/ 10.3389/fmed.2020.624255

De Socio GV, Gidari A, Sicari F, Palumbo M, Francisci D. National Early Warning Score 2 (NEWS2) better predicts critical Coronavirus Disease 2019 (covid-19) illness than covid-GRAM, a multi-centre study. Infection. 2021;1-6. https://doi.org/10.1007/s15010-021- 01620-x

Carr E, Bendayan R, Bean D, Stammers M, Wang W, Zhang H, et al. Evaluation and improvement of the National Early Warning Score (NEWS2) for covid-19: a multi-hospital study. BMC Med. 2021 Jan 21;19(1):23. https://doi.org/10.1186/s12916-020-01893-3

Skitch S, Tam B, Xu M, McInnis L, Vu A, Fox-Robichaud A. Examining the utility of the Hamilton early warning scores (HEWS) at triage: Retrospective pilot study in a Canadian emergency department. CJEM. 2018 Mar;20(2):266-74. https://doi.org/10.1017/cem.2017.21

Hu H, Yao N, Qiu Y. Predictive value of 5 early warning scores for critical covid-19 patients. Disaster Med Public Health Prep. 2022;16(1):232-9. https://doi.org/10.1017/dmp.2020.324

Elguea EPA, Prado BOA, Barradas AJ. Implementación de una escala de gravedad para la activación del equipo de respuesta rápida: NEWS 2. Med Crít. 2019 abr;33(2):98-103.

Shang Y, Liu T, Wei Y, Li J, Shao L, Liu M, et al. Scoring systems for predicting mortality for severe patients with covid-19. EClinicalMedicine. 2020 Jul 3;24:100426. https://doi.org/10.1016/j.eclinm.2020.100426

Xiao LS, Zhang WF, Gong MC, Zhang YP, Chen LY, Zhu HB, et al. Development and validation of the HNC-LL score for predicting the severity of coronavirus disease 2019. EBioMedicine. 2020 Jul;57:102880. https://doi.org/10.1016/j.ebiom.2020.102880

Basbus L, Lapidus MI, Martingano I, Puga MC, Pollán J. índice neutrófilo-linfocito como factor pronóstico de covid-19 [Neutrophil to lymphocyte ratio as a prognostic marker in covid-19]. Medicina (B Aires). 2020;80 Suppl 3:31-6.

Huespe I, Carboni Bisso I, Di Stefano S, Terrasa S, Gemelli NA, Las Heras M. COVID-19 Severity Index: a predictive score for hospitalized patients. Med Intensiva (Engl Ed). 2020;S0210-5691(20)30396-X. https://doi.org/10.1016/j.medin.2020.12.001

Drent M, Cobben NA, Henderson RF, Wouters EF, van Dieijen-Visser M. Usefulness of lactate dehydrogenase and its isoenzymes as indicators of lung damage or inflammation. Eur Respir J. 1996 Aug;9(8):1736-42. https://doi.org/10.1183/09031936.96.09081736

Arias-Reyes C, Carvajal-Rodriguez F, Poma-Machicao L, Aliaga-Raduán F, Marques DA, Zubieta-DeUrioste N, et al. Decreased incidence, virus transmission capacity, and severity of covid-19 at altitude on the American continent. PLoS One. 2021 Mar 29;16(3):e0237294. https://doi.org/10.1371/journal.pone.0237294

Seclén SN, Nunez-Robles E, Yovera-Aldana M, Arias-Chumpitaz A. Incidence of covid-19 infection and prevalence of diabetes, obesity and hypertension according to altitude in Peruvian population. Diabetes Res Clin Pract. 2020 Nov;169:108463. https://doi.org/10.1016/j.diabres.2020.108463

Calderón Gerstein W, López Martínez O. Valores gasométricos en población adulta y adulta mayor residente de gran altitud. An Fac Med. 2020 abr;81(2):154-60.

Paulev PE, Zubieta-Calleja GR. Essentials in the diagnosis of acid-base disorders and their high altitude application. J Physiol Pharmacol. 2005 Sep;56 Suppl 4:155-70.

Zubieta-Calleja G, Zubieta-Castillo G, Zubieta-Calleja L, Ardaya-Zubieta G, Paulev PE. Do over 200 million healthy altitude residents really suffer from chronic Acid-base disorders? Indian J Clin Biochem. 2011 Jan;26(1):62-5. https://doi.org/10.1007/s12291-010-0088-9

Tymko MM, Willie CK, Howe CA, et al. Acid-base balance at high altitude in lowlanders and indigenous highlanders. J Appl Physiol. 1985. 2022;132(2):575-80.

Monge CC, León VF, Lerner BD. El reto fisiológico de vivir en los Andes [internet]. Lima: Instituto Francés de Estudios Andinos; 2003. Disponible en: https://www.ifea.org.pe/libreria/travaux/177/

Helin TA, Lemponen M, Lahtiharju T, Koskinen M, Lassila R, Joutsi-Korhonen L. Anaemia and enhancement of coagulation are associated with severe covid-19 infection. Scand J Clin Lab Invest. 2021;81(8):653-60.

Crooks CJ, West J, Morling JR, et al. Anaemia of acute inflammation: a higher acute systemic inflammatory response is associated with a larger decrease in blood haemoglobin levels in patients with covid-19 infection. Clin Med (Lond). 2023;23(3):201-5.

Viruez-Soto A, López-Dávalos MM, Rada-Barrera G, Merino-Luna A, Molano-Franco D, Tinoco-Solorozano A, Zubieta-DeUrioste N, Zubieta-Calleja G, Arias-Reyes C, Soliz J. Low serum erythropoietin levels are associated with fatal covid-19 cases at 4,150 meters above sea level. Respir Physiol Neurobiol. 2021 Oct;292:103709. https://doi.org/10.1016/j.resp.2021.103709

Soliz J, Schneider-Gasser EM, Arias-Reyes C, Aliaga-Raduan F, Poma-Machicao L, Zubieta-Calleja G, Furuya WI, Trevizan-Baú P, Dhingra RR, Dutschmann M. Coping with hypoxemia: could erythropoietin (EPO) be an adjuvant treatment of covid-19? Respir Physiol Neurobiol. 2020 Aug;279:103476. https://doi.org/10.1016/j.resp.2020.103476

Calderón-Gerstein WS, López-Peña A, Macha-Ramírez R, Bruno-Huamán A, Espejo-Ramos R, Vilchez-Bravo S, et al. Endothelial dysfunction assessment by flow-mediated dilation in a high-altitude population. Vasc Health Risk Manag. 2017 Nov 21;13:421-6. https://doi.org/10.2147/VHRM.S151886

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