Derivation and Validation of a Predictive Score for Disease Worsening in Patients with COVID-19

Grigoris T. Gerotziafas; Theodoros N. Sergentanis; Guillaume Voiriot; Ludovic Lassel; Chryssa Papageorgiou; Alexandre Elabbadi; Matthieu Turpin; Patrick Vandreden; Loula Papageorgiou; Theodora Psaltopoulou; Evangelos Terpos; Meletios-Athanasios Dimopoulos; Antoine Parrot; Jacques Cadranel; Gilles Pialoux; Muriel Fartoukh; Ismail Elalamy

doi:10.1055/s-0040-1716544

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2020; 120(12): 1680-1690
DOI: 10.1055/s-0040-1716544

Coagulation and Fibrinolysis

Derivation and Validation of a Predictive Score for Disease Worsening in Patients with COVID-19

Grigoris T. Gerotziafas

¹Research Group "Cancer, Haemostasis and Angiogenesis," INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France

²Service d’Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires de l’Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine Sorbonne Université, Paris, France

,

Theodoros N. Sergentanis

³Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Guillaume Voiriot

⁴Sorbonne Université, Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France

,

Ludovic Lassel

⁵Service des Maladies Infectieuses et Tropicales, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine Sorbonne Université, Paris, France

,

Chryssa Papageorgiou

⁶Service Anesthésie, Réanimation et Médecine Périopératoire, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine Sorbonne Université, Paris, France

,

Alexandre Elabbadi

⁴Sorbonne Université, Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France

,

Matthieu Turpin

⁴Sorbonne Université, Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France

,

Patrick Vandreden

⁷Clinical Research Department, Diagnostica Stago, Gennevilliers, France

,

Loula Papageorgiou

¹Research Group "Cancer, Haemostasis and Angiogenesis," INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France

²Service d’Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires de l’Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine Sorbonne Université, Paris, France

,

Theodora Psaltopoulou

³Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Evangelos Terpos

³Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Meletios-Athanasios Dimopoulos

³Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Antoine Parrot

⁸Service de pneumologie, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine Sorbonne Université, Paris, France

,

Jacques Cadranel

⁸Service de pneumologie, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine Sorbonne Université, Paris, France

,

Gilles Pialoux

⁵Service des Maladies Infectieuses et Tropicales, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine Sorbonne Université, Paris, France

,

Muriel Fartoukh

⁴Sorbonne Université, Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France

,

Ismail Elalamy

¹Research Group "Cancer, Haemostasis and Angiogenesis," INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France

²Service d’Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires de l’Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine Sorbonne Université, Paris, France

› Author Affiliations

Abstract

The prospective observational cohort study COMPASS-COVID-19 aimed to develop a risk assessment model for early identification of hospitalized COVID-19 patients at risk for worsening disease. Patients with confirmed COVID-19 (n = 430) hospitalized between March 18 and April 21, 2020 were divided in derivation (n = 310) and validation (n = 120) cohorts. Two groups became evident: (1) good prognosis group (G-group) with patients hospitalized at the conventional COVID-19 ward and (2) Worsening disease group (W-group) with patients admitted to the intensive care unit (ICU) from the emergency departments. The study end point was disease worsening (acute respiratory failure, shock, myocardial dysfunction, bacterial or viral coinfections, and acute kidney injury) requiring ICU admission. All patients were routinely evaluated for full blood count, prothrombin time, fibrinogen, D-dimers, antithrombin (AT), and protein C activity. Data from the first hospitalization day at the conventional ward or the ICU were analyzed. Cardiovascular risk factors and comorbidities were routinely registered. Obesity, hypertension, diabetes and male gender, increased fibrinogen and D-dimers, thrombocytopenia, AT deficiency, lymphopenia, and an International Society on Thrombosis and Haemostasis (ISTH) score for compensated disseminated intravascular coagulation score (cDIC-ISTH) ≥5 were significant risk factors for worsening disease. The COMPASS-COVID-19 score was derived from multivariate analyses and includes obesity, gender, hemoglobin, lymphocyte, and the cDIC-ISTH score (including platelet count, prothrombin time, D-dimers, AT, and protein C levels). The score has a very good discriminating capacity to stratify patients at high and low risk for worsening disease, with an area under the receiver operating characteristic curve value of 0.77, a sensitivity of 81%, and a specificity of 60%. Application of the COMPASS-COVID-19 score at the validation cohort showed 96% sensitivity. The COMPASS-COVID-19 score is an accurate clinical decision-making tool for an easy identification of COVID-19 patients being at high risk for disease worsening.

Keywords

COVID-19 - SARS-CoV-2 - disseminated intravascular coagulation - antithrombin - D-dimers

Full Text

References

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