Prognostic significance of CHADS₂ and CHA₂DS₂-VASc scores to predict unfavorable outcomes in hospitalized patients with COVID-19

Abstract

Introduction: Owing to the imposed burden of the coronavirus disease 2019 (COVID-19),the need for stratifying the prognosis of patients has never been timelier. Hence, we aimed to ascertain the value of CHADS₂, CHA₂DS₂-VASc, and CHA₂DS₂-VASc-M (one point for male instead of female) scores to predict unfavorable outcomes in COVID-19 patients.
Methods: We enrolled consecutive patients above 18 years of age with confirmed COVID-19,who were admitted between February 16 and November 1, 2020. The primary endpoint of this study was three-month all-cause mortality. The secondary endpoints were considered four major in-hospital clinical features, including acute respiratory distress syndrome, cardiac injury,acute kidney injury, and mechanical ventilation.
Results: A total of 1,406 hospitalized COVID-19 patients were studied, among which 301(21.40%) patients died during the follow-up period. Regarding the risk scores, CHADS ₂≥1,CHA₂DS₂-VASc≥2, and CHA₂DS₂-VASc-M≥2 were significantly associated with mortality. The performance of all risk scores for predicting mortality was satisfactory (area under the curve:0.668, 0.668, and 0.681, respectively). Appraising secondary endpoints, we found that all three risk scores were associated with increased risk of acute respiratory distress syndrome, cardiac injury, acute kidney injury, and mechanical ventilation. Lastly, we revealed that all risk scores were significantly correlated with serum levels of laboratory biomarkers.
Conclusion: Our analysis illustrated that the CHADS₂, CHA2DS₂-VASc, and CHA₂DS₂-VASc-Mscores could aid prognostication of unfavorable outcomes in COVID-19 patients. Therefore,these easily calculable methods could be integrated into the overall therapeutic strategy to guide the COVID-19 management more accurately.

Keywords: Acute Kidney Injury, Acute Respiratory Distress Syndrome, Cardiac Injury, COVID-19, Mortality