.: ORİJİNAL ARAŞTIRMA
The Role of CHA2DS2-VASc Score in Predicting Intensive Care Unit Admission in Patients with COVID-19: Retrospective Study
CHA2DS2-VASc Skorunun COVID-19 Hastalarında Yoğun Bakım İhtiyacını Öngörmedeki Yeri: Retrospektif Çalışma
Turkiye Klinikleri J Med Sci. 2021;41(4):424-30
doi: 10.5336/medsci.2021-84677
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: The CHA2DS2-VASc is a risk score used to determine the embolic risk in patients with atrial fibrillation. Also, its efficacy for prognosis has been demonstrated in other clinical situations. The coronavirus disease-2019 (COVID-19) disease is characterized by pneumonia, respiratory failure, venous and arterial thrombosis leading to multiorgan failure and mortality. Therefore, in this study, we aimed to show the predictive value of the CHA2DS2-VASc score to determine the need for intensive care unite admission in COVID-19 patients and its correlation with serum Ddimer levels. Material and Methods: Patients admitted to the hospital due to COVID-19 disease confirmed with a polymerase chain reaction test were evaluated, and those over 18 years of age were included in the study prospectively. Each patients' CHA2DS2-VASc score was calculated, also Ddimer and other laboratory parameters were recorded. Factors related to intensive care unit admission were evaluated. Results: Overall, 110 patients were included in the study. Among these, 16 patients needed intensive care unite admission. The CHA2DS2-VASc score was found to be an independent predictor of intensive care unite admission [Odds ratio: 1.94 (1.32-2.85 95% confidence interval), p=0.001]. Receiver operating characteristic analysis revealed that the 1.5 cut-off value predicted intensive care unit admission with a 75% sensitivity and specificity. There was also a significant correlation between the CHA2DS2-VASc risk score and serum D-dimer levels (p<0.001, r=0.34). Conclusion: The CHA2DS2-VASc risk score can be used to predict intensive care unit admission in COVID-19 patients, and it is correlated with serum D-dimer levels.
Keywords: COVID-19; CHA2DS2-VASc; D-dimer; thromboembolism, intensive care
Objective: The CHA2DS2-VASc is a risk score used to determine the embolic risk in patients with atrial fibrillation. Also, its efficacy for prognosis has been demonstrated in other clinical situations. The coronavirus disease-2019 (COVID-19) disease is characterized by pneumonia, respiratory failure, venous and arterial thrombosis leading to multiorgan failure and mortality. Therefore, in this study, we aimed to show the predictive value of the CHA2DS2-VASc score to determine the need for intensive care unite admission in COVID-19 patients and its correlation with serum Ddimer levels. Material and Methods: Patients admitted to the hospital due to COVID-19 disease confirmed with a polymerase chain reaction test were evaluated, and those over 18 years of age were included in the study prospectively. Each patients' CHA2DS2-VASc score was calculated, also Ddimer and other laboratory parameters were recorded. Factors related to intensive care unit admission were evaluated. Results: Overall, 110 patients were included in the study. Among these, 16 patients needed intensive care unite admission. The CHA2DS2-VASc score was found to be an independent predictor of intensive care unite admission [Odds ratio: 1.94 (1.32-2.85 95% confidence interval), p=0.001]. Receiver operating characteristic analysis revealed that the 1.5 cut-off value predicted intensive care unit admission with a 75% sensitivity and specificity. There was also a significant correlation between the CHA2DS2-VASc risk score and serum D-dimer levels (p<0.001, r=0.34). Conclusion: The CHA2DS2-VASc risk score can be used to predict intensive care unit admission in COVID-19 patients, and it is correlated with serum D-dimer levels.
Keywords: COVID-19; CHA2DS2-VASc; D-dimer; thromboembolism, intensive care
ÖZET
Amaç: CHA2DS2-VASc, atriyal fibrilasyon hastalarında embolik riskin belirlenmesi için kullanılan bir skordur. Ek olarak başka klinik olaylarda da prognostik açıdan değerli olduğu çalışmalarla gösterilmiştir. Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)], çoklu organ yetersizliği ve ölüme yol açabilen, pnömoni, solunum yetersizliği, arteriyel ve venöz trombozlar ile karakterize bir hastalıktır. Bu nedenle, bu çalışmada, CHA2DS2-VASc skorunun, COVID-19 hastalarında yoğun bakım ihtiyacını öngörmedeki yerini ve serum D-dimer düzeyleri ile arasındaki ilişkiyi ortaya koymayı amaçladık. Gereç ve Yöntemler: Bu retrospektif çalışmaya, COVID-19 nedeniyle hastaneye başvuran ve polimeraz zincir reaksiyonu testi ile tanısı doğrulanan, 18 yaş ve üzeri hastalar dâhil edildi. Tüm hastaların CHA2DS2-VASc skorları hesaplandı; D-dimer ve diğer laboratuvar tetkikleri kayıt edildi. Yoğun bakım ihtiyacı ile ilişkili olabilecek faktörler kaydedildi. Bulgular: Çalışmaya toplam 110 hasta dâhil edildi. Bu hastaların 16'sında yoğun bakım ihtiyacı gelişti. CHA2DS2-VASc skorunun, yoğun bakım ihtiyacının bağımsız bir öngörücüsü olduğu sonucu bulundu [Odds ratio: 1,94 (1,32-2,85 %95 güven aralığı), p=0,001]. Alıcı işletim karakteristiği analizi, 1,5 sınır değer ve üzerinde, bu skorun %75 duyarlılık ve özgüllük ile yoğun bakım ihtiyacını öngörebildiğini ortaya koydu. Ayrıca CHA2DS2-VASc skoru ile D-dimer düzeyleri arasında anlamlı korelasyon saptandı (p<0,001; r=0,34). Sonuç: CHA2DS2-VASc risk skoru, COVID-19 hastalarında yoğun bakım ihtiyacını öngörmede kullanılabilir ve D-dimer düzeyleri ile de koreledir.
Anahtar Kelimeler: COVID-19; CHA2DS2-VASc; D-dimer; tromboembolizm, yoğun bakım
Amaç: CHA2DS2-VASc, atriyal fibrilasyon hastalarında embolik riskin belirlenmesi için kullanılan bir skordur. Ek olarak başka klinik olaylarda da prognostik açıdan değerli olduğu çalışmalarla gösterilmiştir. Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)], çoklu organ yetersizliği ve ölüme yol açabilen, pnömoni, solunum yetersizliği, arteriyel ve venöz trombozlar ile karakterize bir hastalıktır. Bu nedenle, bu çalışmada, CHA2DS2-VASc skorunun, COVID-19 hastalarında yoğun bakım ihtiyacını öngörmedeki yerini ve serum D-dimer düzeyleri ile arasındaki ilişkiyi ortaya koymayı amaçladık. Gereç ve Yöntemler: Bu retrospektif çalışmaya, COVID-19 nedeniyle hastaneye başvuran ve polimeraz zincir reaksiyonu testi ile tanısı doğrulanan, 18 yaş ve üzeri hastalar dâhil edildi. Tüm hastaların CHA2DS2-VASc skorları hesaplandı; D-dimer ve diğer laboratuvar tetkikleri kayıt edildi. Yoğun bakım ihtiyacı ile ilişkili olabilecek faktörler kaydedildi. Bulgular: Çalışmaya toplam 110 hasta dâhil edildi. Bu hastaların 16'sında yoğun bakım ihtiyacı gelişti. CHA2DS2-VASc skorunun, yoğun bakım ihtiyacının bağımsız bir öngörücüsü olduğu sonucu bulundu [Odds ratio: 1,94 (1,32-2,85 %95 güven aralığı), p=0,001]. Alıcı işletim karakteristiği analizi, 1,5 sınır değer ve üzerinde, bu skorun %75 duyarlılık ve özgüllük ile yoğun bakım ihtiyacını öngörebildiğini ortaya koydu. Ayrıca CHA2DS2-VASc skoru ile D-dimer düzeyleri arasında anlamlı korelasyon saptandı (p<0,001; r=0,34). Sonuç: CHA2DS2-VASc risk skoru, COVID-19 hastalarında yoğun bakım ihtiyacını öngörmede kullanılabilir ve D-dimer düzeyleri ile de koreledir.
Anahtar Kelimeler: COVID-19; CHA2DS2-VASc; D-dimer; tromboembolizm, yoğun bakım
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