• Valente SilvaBeatrizBCardiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Centro Académico de Medicina de Lisboa. Centro Cardiovascular da Universidade de Lisboa. Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal., Rui Plácido, Cláudia Jorge, Carlos Mendonça, Maria Luísa Urbano, Tiago Rodrigues, Joana Brito, Alves da SilvaPedroPCardiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Centro Académico de Medicina de Lisboa. Centro Cardiovascular da Universidade de Lisboa. Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal., Joana Rigueira, and Fausto J Pinto.
• Cardiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Centro Académico de Medicina de Lisboa. Centro Cardiovascular da Universidade de Lisboa. Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal.
• Acta Medica Port. 2022 Jun 1; 35 (6): 433-442.

IntroductionRisk factors comprising the CHA2DS2VASc score are recognized as risk factors for venous thromboembolism and mortality in COVID-19 patients. A modified CHA2DS2VASc score (M-CHA2D2VASc), developed by changing gender criteria from female to male, has been proposed to predict in-hospital mortality in COVID-19 patients. The aim of this study was to evaluate the prognostic accuracy of M-CHA2D2VASc for adverse clinical outcomes and short-term mortality in COVID-19 patients admitted to the Emergency Department.Material And MethodsRetrospective study of patients admitted to the ED who underwent computed tomography pulmonary angiography due to suspected pulmonary embolism or clinical worsening. Patients were stratified into three M-CHA2DS2-VASc risk-categories: low (0 - 1 points), intermediate (2 - 3 points) and high-risk (≥ 4 points).ResultsWe included 300 patients (median age 71 years, 59% male). The overall mortality was 27%. The M-CHA2DS2-VASc score was higher in non-survivors compared to survivors [4 (IQR:3 - 5) vs 2 (IQR: 1 - 4), respectively, p < 0.001). The M-CHA2DS2-VASc score was identified as an independent predictor of mortality in a multivariable logistic regression model (OR 1.406, p = 0.007). The Kaplan-Meier survival curves showed that the M-CHA2DS2-VASc score was associated with short-term mortality (log-rank test < 0.001), regardless of hospitalization (log-rank test p < 0.001 and p = 0.007, respectively). The survival proportion was 92%, 80% and 63% in the lower, intermediate, and higher risk-groups. As for the risk-categories, no difference was found in pulmonary embolism, Intensive Care Unit admission, and invasive mechanical ventilation.DiscussionThis is the first study to validate M-CHA2DS2-VASc score as a predictor of short-term mortality in patients admitted to the Emergency Department.ConclusionThe M-CHA2DS2-VASC score might be useful for prompt risk-stratification in COVID-19 patients during admission to the Emergency Department.

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