Assessment of the ABC2-SPH risk score to predict invasive mechanical ventilation in COVID-19 patients and comparison to other scores
Authors: Cimini Christiane Corrêa Rodrigues , Delfino-Pereira Polianna , Pires Magda Carvalho , Ramos Lucas Emanuel Ferreira , Gomes Angélica Gomides dos Reis , Jorge Alzira de Oliveira , Fagundes Ariovaldo Leal , Garcia Bárbara Machado , Pessoa Bruno Porto , de Carvalho Cíntia Alcantara , Ponce Daniela , Rios Danyelle Romana Alves , Anschau Fernando , Vigil Flavia Maria Borges , Bartolazzi Frederico , Grizende Genna Maira Santos , Vietta Giovanna Grunewald , Goedert Giulia Maria dos Santos , Nascimento Guilherme Fagundes , Vianna Heloisa Reniers , Vasconcelos Isabela Muzzi , de Alvarenga Joice Coutinho , Chatkin José Miguel , Machado Rugolo Juliana , Ruschel Karen Brasil , Zandoná Liege Barella , Menezes Luanna Silva Monteiro , de Castro Luís César , Souza Maíra Dias , Carneiro Marcelo , Bicalho Maria Aparecida Camargos , Cunha Maria Izabel Alcântara , Sacioto Manuela Furtado , de Oliveira Neimy Ramos , Andrade Pedro Guido Soares , Lutkmeier Raquel , Menezes Rochele Mosmann , Ribeiro Antonio Luiz Pinho , Marcolino Milena Soriano 
Published: November 2023

Background

Predicting the need for invasive mechanical ventilation (IMV) is important for the allocation of human and technological resources, improvement of surveillance, and use of effective therapeutic measures. This study aimed (i) to assess whether the ABC2-SPH score is able to predict the receipt of IMV in COVID-19 patients; (ii) to compare its performance with other existing scores; (iii) to perform score recalibration, and to assess whether recalibration improved prediction.

Methods

Retrospective observational cohort, which included adult laboratory-confirmed COVID-19 patients admitted in 32 hospitals, from 14 Brazilian cities. This study was conducted in two stages: (i) for the assessment of the ABC2-SPH score and comparison with other available scores, patients hospitalized from July 31, 2020, to March 31, 2022, were included; (ii) for ABC2-SPH score recalibration and also comparison with other existing scores, patients admitted from January 1, 2021, to March 31, 2022, were enrolled. For both steps, the area under the receiving operator characteristic score (AUROC) was calculated for all scores, while a calibration plot was assessed only for the ABC2-SPH score. Comparisons between ABC2-SPH and the other scores followed the Delong Test recommendations. Logistic recalibration methods were used to improve results and adapt to the studied sample.

Results

Overall, 9,350 patients were included in the study, the median age was 58.5 (IQR 47.0–69.0) years old, and 45.4% were women. Of those, 33.5% were admitted to the ICU, 25.2% received IMV, and 17.8% died. The ABC2-SPH score showed a significantly greater discriminatory capacity, than the CURB-65, STSS, and SUM scores, with potentialized results when we consider only patients younger than 80 years old (AUROC 0.714 [95% CI 0.698–0.731]). Thus, after the ABC2-SPH score recalibration, we observed improvements in calibration (slope = 1.135, intercept = 0.242) and overall performance (Brier score = 0.127).

Conclusion

The ABC2-SPHr risk score demonstrated a good performance to predict the need for mechanical ventilation in COVID-19 hospitalized patients under 80 years of age.