External validation of prognostic scores for Covid-19: a multicenter cohort study of patients hospitalized in Greater Paris University Hospitals

Yannis Lombardi (1) , Loris Azoyan (1) , Piotr Szychowiak (2) , Ali Bellamine (3) , Guillaume Lemaitre (4) , Mélodie Bernaux (3) , Christel Daniel (3, 5) , Judith Leblanc (6) , Quentin Riller (7) , Olivier Steichen (8, 6)

1 SU - Sorbonne Université
2 CHU Trousseau [Tours]
3 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
4 Inria Siège
5 LIMICS - Laboratoire d'Informatique Médicale et Ingénierie des Connaissances en e-Santé
6 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
7 CHU Pitié-Salpêtrière [AP-HP]
8 CHU Tenon [AP-HP]

The Coronavirus disease 2019 (Covid-19) has led to an unparalleled influx of patients. Prognostic scores could help optimizing healthcare delivery, but most of them have not been comprehensively validated. We aim to externally validate existing prognostic scores for Covid-19. Methods We used "Covid-19 EvidenceAlerts" (McMaster University) to retrieve high-quality prognostic scores predicting death or intensive care unit (ICU) transfer from routinely collected data. We studied their accuracy in a retrospective multicentre cohort of adult patients hospitalized for Covid-19 from January 2020 to April 2021 in the Greater Paris University Hospitals. Areas under the receiver operating characteristic curves (AUC) were computed for the prediction of the original outcome, 30-day in-hospital mortality and the composite of 30-day in-hospital mortality or ICU transfer. Results We included 14,343 consecutive patients, 2,583 (18%) died and 5,067 (35%) died or were transferred to the ICU. We examined 274 studies and found 32 scores meeting the inclusion criteria: 19 had a significantly lower AUC in our cohort than in previously published validation studies for the original outcome; 25 performed better to predict in-hospital mortality than the composite of in-hospital mortality or ICU transfer; 7 had an AUC >0.75 to predict in-hospital mortality; 2 had an AUC >0.70 to predict the composite outcome. Conclusion Seven prognostic scores were fairly accurate to predict death in hospitalized Covid-19 patients. The 4C Mortality Score and the ABCS stand out because they performed as well in our cohort and their initial validation cohort, during the first epidemic wave and subsequent waves, and in younger and older patients.

Mots clés: Covid-19; SARS-CoV2; Prognosis; Intensive Care Units; Mortality; Cohort Studies

Domaines: Virologie

Yannis Lombardi, Loris Azoyan, Piotr Szychowiak, Ali Bellamine, Guillaume Lemaitre, et al.. External validation of prognostic scores for Covid-19: a multicenter cohort study of patients hospitalized in Greater Paris University Hospitals. Intensive Care Medicine, 2021, ⟨10.1007/s00134-021-06524-w⟩. ⟨hal-03967472v1⟩