• Manuel Rubio-Rivas, José María Mora-Luján, Francesc Formiga, Coral Arévalo-Cañas, Juan Manuel Lebrón Ramos, María Victoria Villalba García, Eva Mª Fonseca Aizpuru, Jesús Díez-Manglano, Francisco Arnalich Fernández, Romero CabreraJuan LuisJLLipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain.CIBER Fisiopatología de la Obes, Gema María García García, Paula M Pesqueira Fontan, Juan Antonio Vargas Núñez, Santiago Jesús Freire Castro, José Loureiro Amigo, Maria de Los Reyes Pascual Pérez, José N Alcalá Pedrajas, Daniel Encinas-Sánchez, Mella PérezCarmenCDepartment of Internal Medicine, Ferrol Clinical University Hospital, Ferrol, La Coruña, Spain., Javier Ena, Anyuli Gracia Gutiérrez, María José Esteban Giner, José F Varona, Jesús Millán Núñez-Cortés, José-Manuel Casas-Rojo, and SEMI-COVID-19 Network.
• Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain. mrubio@bellvitgehospital.cat.
• J Gen Intern Med. 2022 Jun 1; 37 (8): 198019871980-1987.

BackgroundThe WHO ordinal severity scale has been used to predict mortality and guide trials in COVID-19. However, it has its limitations.ObjectiveThe 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.DesignRetrospective 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 ResultsA 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.ConclusionsThe 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.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

12 keywords...

hide…