WHO Ordinal Scale and Inflammation Risk Categories in COVID-19. Comparative Study of the Severity Scales

Background The WHO ordinal severity scale has been used to predict mortality and guide trials in COVID-19. However, it has its limitations. Objective The present study aims to compare three classificatory and predictive models: the WHO ordinal severity scale, the model based on inflammation grades,...

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Autores: Rubio-Rivas M, Mora-Luján JM, Formiga F, Arévalo-Cañas C, Lebrón Ramos JM, Villalba García MV, Fonseca Aizpuru EM, Díez-Manglano J, Arnalich Fernández F, Romero Cabrera JL, García García GM, Pesqueira Fontan PM, Vargas Núñez JA, Freire Castro SJ, Loureiro Amigo J, Pascual Pérez MLR, Alcalá Pedrajas JN, Encinas-Sánchez D, Mella Pérez C, Ena J, Gracia Gutiérrez A, Esteban Giner MJ, Varona JF, Millán Núñez-Cortés J, Casas-Rojo JM, SEMI-COVID-19 Network
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p13485
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/13485
Access Level:acceso abierto
Palabra clave:COVID-19
prognosis
WHO ordinal scale
inflammation
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spelling WHO Ordinal Scale and Inflammation Risk Categories in COVID-19. Comparative Study of the Severity ScalesRubio-Rivas MMora-Luján JMFormiga FArévalo-Cañas CLebrón Ramos JMVillalba García MVFonseca Aizpuru EMDíez-Manglano JArnalich Fernández FRomero Cabrera JLGarcía García GMPesqueira Fontan PMVargas Núñez JAFreire Castro SJLoureiro Amigo JPascual Pérez MLRAlcalá Pedrajas JNEncinas-Sánchez DMella Pérez CEna JGracia Gutiérrez AEsteban Giner MJVarona JFMillán Núñez-Cortés JCasas-Rojo JMSEMI-COVID-19 NetworkCOVID-19prognosisWHO ordinal scaleinflammationBackground The WHO ordinal severity scale has been used to predict mortality and guide trials in COVID-19. However, it has its limitations. Objective The present study aims to compare three classificatory and predictive models: the WHO ordinal severity scale, the model based on inflammation grades, and the hybrid model. Design Retrospective cohort study with patient data collected and followed up from March 1, 2020, to May 1, 2021, from the nationwide SEMI-COVID-19 Registry. The primary study outcome was in-hospital mortality. As this was a hospital-based study, the patients included corresponded to categories 3 to 7 of the WHO ordinal scale. Categories 6 and 7 were grouped in the same category. Key Results A total of 17,225 patients were included in the study. Patients classified as high risk in each of the WHO categories according to the degree of inflammation were as follows: 63.8% vs. 79.9% vs. 90.2% vs. 95.1% (p<0.001). In-hospital mortality for WHO ordinal scale categories 3 to 6/7 was as follows: 0.8% vs. 24.3% vs. 45.3% vs. 34% (p<0.001). In-hospital mortality for the combined categories of ordinal scale 3a to 5b was as follows: 0.4% vs. 1.1% vs. 11.2% vs. 27.5% vs. 35.5% vs. 41.1% (p<0.001). The predictive regression model for in-hospital mortality with our proposed combined ordinal scale reached an AUC=0.871, superior to the two models separately. Conclusions The present study proposes a new severity grading scale for COVID-19 hospitalized patients. In our opinion, it is the most informative, representative, and predictive scale in COVID-19 patients to date.Springer Verlag2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fisabio.portalinvestigacion.com/publicaciones/13485JOURNAL OF GENERAL INTERNAL MEDICINEISSN: 15251497ISSNe: 08848734reponame:r-FISABIO. Repositorio Institucional de Producción Científicainstname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)Inglésinfo:eu-repo/semantics/openAccessoai:fisabio.fundanetsuite.com:p134852026-06-11T12:45:17Z
dc.title.none.fl_str_mv WHO Ordinal Scale and Inflammation Risk Categories in COVID-19. Comparative Study of the Severity Scales
title WHO Ordinal Scale and Inflammation Risk Categories in COVID-19. Comparative Study of the Severity Scales
spellingShingle WHO Ordinal Scale and Inflammation Risk Categories in COVID-19. Comparative Study of the Severity Scales
Rubio-Rivas M
COVID-19
prognosis
WHO ordinal scale
inflammation
title_short WHO Ordinal Scale and Inflammation Risk Categories in COVID-19. Comparative Study of the Severity Scales
title_full WHO Ordinal Scale and Inflammation Risk Categories in COVID-19. Comparative Study of the Severity Scales
title_fullStr WHO Ordinal Scale and Inflammation Risk Categories in COVID-19. Comparative Study of the Severity Scales
title_full_unstemmed WHO Ordinal Scale and Inflammation Risk Categories in COVID-19. Comparative Study of the Severity Scales
title_sort WHO Ordinal Scale and Inflammation Risk Categories in COVID-19. Comparative Study of the Severity Scales
dc.creator.none.fl_str_mv Rubio-Rivas M
Mora-Luján JM
Formiga F
Arévalo-Cañas C
Lebrón Ramos JM
Villalba García MV
Fonseca Aizpuru EM
Díez-Manglano J
Arnalich Fernández F
Romero Cabrera JL
García García GM
Pesqueira Fontan PM
Vargas Núñez JA
Freire Castro SJ
Loureiro Amigo J
Pascual Pérez MLR
Alcalá Pedrajas JN
Encinas-Sánchez D
Mella Pérez C
Ena J
Gracia Gutiérrez A
Esteban Giner MJ
Varona JF
Millán Núñez-Cortés J
Casas-Rojo JM
SEMI-COVID-19 Network
author Rubio-Rivas M
author_facet Rubio-Rivas M
Mora-Luján JM
Formiga F
Arévalo-Cañas C
Lebrón Ramos JM
Villalba García MV
Fonseca Aizpuru EM
Díez-Manglano J
Arnalich Fernández F
Romero Cabrera JL
García García GM
Pesqueira Fontan PM
Vargas Núñez JA
Freire Castro SJ
Loureiro Amigo J
Pascual Pérez MLR
Alcalá Pedrajas JN
Encinas-Sánchez D
Mella Pérez C
Ena J
Gracia Gutiérrez A
Esteban Giner MJ
Varona JF
Millán Núñez-Cortés J
Casas-Rojo JM
SEMI-COVID-19 Network
author_role author
author2 Mora-Luján JM
Formiga F
Arévalo-Cañas C
Lebrón Ramos JM
Villalba García MV
Fonseca Aizpuru EM
Díez-Manglano J
Arnalich Fernández F
Romero Cabrera JL
García García GM
Pesqueira Fontan PM
Vargas Núñez JA
Freire Castro SJ
Loureiro Amigo J
Pascual Pérez MLR
Alcalá Pedrajas JN
Encinas-Sánchez D
Mella Pérez C
Ena J
Gracia Gutiérrez A
Esteban Giner MJ
Varona JF
Millán Núñez-Cortés J
Casas-Rojo JM
SEMI-COVID-19 Network
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv COVID-19
prognosis
WHO ordinal scale
inflammation
topic COVID-19
prognosis
WHO ordinal scale
inflammation
description Background The WHO ordinal severity scale has been used to predict mortality and guide trials in COVID-19. However, it has its limitations. Objective The present study aims to compare three classificatory and predictive models: the WHO ordinal severity scale, the model based on inflammation grades, and the hybrid model. Design Retrospective cohort study with patient data collected and followed up from March 1, 2020, to May 1, 2021, from the nationwide SEMI-COVID-19 Registry. The primary study outcome was in-hospital mortality. As this was a hospital-based study, the patients included corresponded to categories 3 to 7 of the WHO ordinal scale. Categories 6 and 7 were grouped in the same category. Key Results A total of 17,225 patients were included in the study. Patients classified as high risk in each of the WHO categories according to the degree of inflammation were as follows: 63.8% vs. 79.9% vs. 90.2% vs. 95.1% (p<0.001). In-hospital mortality for WHO ordinal scale categories 3 to 6/7 was as follows: 0.8% vs. 24.3% vs. 45.3% vs. 34% (p<0.001). In-hospital mortality for the combined categories of ordinal scale 3a to 5b was as follows: 0.4% vs. 1.1% vs. 11.2% vs. 27.5% vs. 35.5% vs. 41.1% (p<0.001). The predictive regression model for in-hospital mortality with our proposed combined ordinal scale reached an AUC=0.871, superior to the two models separately. Conclusions The present study proposes a new severity grading scale for COVID-19 hospitalized patients. In our opinion, it is the most informative, representative, and predictive scale in COVID-19 patients to date.
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fisabio.portalinvestigacion.com/publicaciones/13485
url https://fisabio.portalinvestigacion.com/publicaciones/13485
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Springer Verlag
publisher.none.fl_str_mv Springer Verlag
dc.source.none.fl_str_mv JOURNAL OF GENERAL INTERNAL MEDICINE
ISSN: 15251497
ISSNe: 08848734
reponame:r-FISABIO. Repositorio Institucional de Producción Científica
instname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
instname_str Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
reponame_str r-FISABIO. Repositorio Institucional de Producción Científica
collection r-FISABIO. Repositorio Institucional de Producción Científica
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.812429

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