Objective: Coronavirus disease 2019 (COVID-19) is a disease with a high rate of progression to critical illness. However, the stratification of patients at risk of mortality is not well defined. In this study, we aimed to define a mortality risk index to allocate patients to the appropriate intensity of care.
Methods: This is a 12 months observational longitudinal study designed to develop and validate a pragmatic mortality risk score to stratify COVID-19 patients aged ≥18 years and admitted to hospital between March 2020 and March 2021. Main outcome was in-hospital mortality.
Results: 244 patients were included in the study (mortality rate 29.9%). The Covid-19 Assessment for Survival at Admission (CASA) index included seven variables readily available at admission: respiratory rate, troponin, albumin, CKD-EPI, white blood cell count, D-dimer, Pa02/Fi02. The CASA index showed high discrimination for mortality with an AUC of 0.91 (sensitivity 98.6%; specificity 69%) and a better performance compared to SOFA (AUC = 0.76), age (AUC = 0.76) and 4C mortality (AUC = 0.82). The cut-off identified (11.994) for CASA index showed a negative predictive value of 99.16% and a positive predictive value of 57.58%.
Conclusions: A quick and readily available index has been identified to help clinicians stratify COVID-19 patients according to the appropriate intensity of care and minimize hospital admission to patients at high risk of mortality.
Digital Object Identifier (DOI)
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmed.2021.719976/full#supplementary-material The material is also available for download as the additional file listed at the end of this record.
Bagnato, Gianluca; La Rosa, Daniela; Ioppolo, Carmelo; De Gaetano, Alberta; Chiappalone, Marianna; Zirilli, Natalia; Viapiana, Valeria; Tringali, Maria Concetta; Tomeo, Simona; Aragona, Caterina Oriana; Napoli, Francesca; Lillo, Sara; Irrera, Natasha; Roberts, William Neal; Imbalzano, Egidio; Micari, Antonio; Spagnolo, Elvira Ventura; Squadrito, Giovanni; Gangemi, Sebastiano; and Versace, Antonio Giovanni, "The COVID-19 Assessment for Survival at Admission (CASA) Index: A 12 Months Observational Study" (2021). Internal Medicine Faculty Publications. 262.