Mortality Predictive Value of the C2HEST Score in Elderly Subjects with COVID-19—A Subanalysis of the COLOS Study

Abstract

Senility has been identified among the strongest risk predictors for unfavorable COVID-19-outcome. However, even in the elderly population, the clinical course of infection in individual patients remains unpredictable. Hence, there is an urgent need for developing a simple tool predicting adverse COVID-19-outcomes. We assumed that the C2HEST-score could predict unfavorable clinical outcomes in the elderly subjects with COVID-19-subjects. Methods: We retrospectively analyzed 1047 medical records of patients at age > 65 years, hospitalized at the medical university center due to COVID-19. Subsequently, patients were divided into three categories depending on their C2HEST-score result. Results: We noticed significant differences in the in-hospital and 3-month and 6-month mortality-which was the highest in high-risk-C2HEST-stratum reaching 35.7%, 54.4%, and 65.9%, respectively. The medium-risk-stratum mortalities reached 24.1% 43.4%, and 57.6% and for low-risk-stratum 14.4%, 25.8%, and 39.2% respectively. In the C2HEST-score model, a change from the low to the medium category increased the probability of death intensity approximately two-times. Subsequently, transfer from the low-risk to the high-risk-stratum raised all-cause-death-intensity 2.7-times. Analysis of the secondary outcomes revealed that the C2HEST-score has predictive value for acute kidney injury, acute heart failure, and cardiogenic shock. Conclusions: C2HEST-score analysis on admission to the hospital may predict the mortality, acute kidney injury, and acute heart failure in elderly subjects with COVID-19.

Usefulness of the Veterans Health Administration COVID-19 (VACO) Index for Predicting Short-Term Mortality among Patients of the COLOS Study

“…These predicted values by the C2HEST score were comparable to values predicted by the VACO index and presented in this article. Our previously published papers [17,18] state that the elderly population is more likely to be hospitalized or admitted to an intensive care unit and that advanced age has a positive correlation with increasing hospitalization time. In our study, patients from the extreme risk stratum had the longest hospitalization time when compared to patients from other risk groups.…”

Usefulness of C2HEST Score in Predicting Clinical Outcomes of COVID-19 in Heart Failure and Non-Heart-Failure Cohorts

“…Unfortunately, a simple, fast, well-validated scoring system dedicated to the HF subpopulation is still missing. Taking into account some encouraging data from our previous analyses concerning other subpopulations of COVID-19 patients [ 8 , 9 , 19 ], we decided to validate the C 2 HEST score system in terms of heart failure subjects.…”

“…However, recently, Liang et al [ 7 ] demonstrated that C 2 HEST score could also predict adverse clinical outcomes, including death and hospitalization, among patients with heart failure. Considering that individual components of the C 2 HEST (C2: CAD/COPD; H: Hypertension; E: Elderly (Age ≥ 75); S: Systolic HF; T: Thyroid disease) are parallel to COVID-19 mortality risk factors, juxtaposing it with the outcomes of recently published studies [ 8 , 9 , 10 ] suggesting that this simple scoring system has the ability to predict outcomes in several COVID-19 subpopulations, we designed this study to evaluate the predictive value of C 2 HEST score in patients with heart failure (HF).…”

Clinical Features of COVID-19 in Elderly Patients: Tools for Predicting Outcomes Are Needed

“…Along with hypoxemic respiratory failure, acute decompensation of pre-existent comorbidities within the first week of infection was the most common cause of death [22]. Several studies investigated prognostic factors in elderlies with COVID-19 infections [23][24][25][26][27]. Scheffler et al investigated the prognostic role of subcutaneous and visceral adipose tissue using a quantification fat area on 64 patients with a mean age of 86.4 ± 6.0 years [23].…”

“…The C 2 HEST is a stratification scoring system to assesses the risk of developing atrial fibrillation. Rola et al [25] demonstrated that the C 2 HEST was effective in predicting six-month and in-hospital mortality in 1047 elderlies with COVID-19. Moreover, the C 2 HEST was also valid in predicting the risk of non-fatal events, including cardiogenic shock and acute kidney and heart failure in elderlies affected by COVID-19 [25].…”