Burhan ASLAN, Ümit İNCİ, Ferhat IŞIK, Mehmet Zülküf KARAHAN, Murat ÇAP, İsmail TATLI, Bedrettin BOYRAZ, Metin OKŞUL

Evaluation of the Modified HASBLED Score for Prediction of In-hospital Mortality in Patients with COVID-19

Objective: The COVID-19 outbreak continues to be the common cause of deaths worldwide in recent times. Preventing poor outcomes (death, intubation, non-invasive ventilation, need for intensive care) is the first goal for hospitalized patients. Identifying high-risk patients during hospitalization can provide more effective follow-up and treatment. The HASBLED score is highly predictive for bleeding events in atrial fibrillation patients. We used the HASBLED score to identify patients with frailty, vulnerability, and comorbid diseases, not as a bleeding score. So, we used albumin level instead of labile INR in the score because it shows both the nutritional status and inflammation. We aim to evaluate the modified HASBLED score for predicting mortality and poor outcomes in hospitalized COVID-19 patients. Method: In total, 2850 hospitalized COVID-19 patients were screened retrospectively and, after the exclusions, 2041 patients were included in the study. The patients were divided into two groups according to the M-HASBLED score as

Keywords:

HASBLED score, mortality, COVID-19, hospitalization,

PDF

___

1. World Health Organization (WHO). Coronavirus disease (COVID-19) outbreak, https://www.who.int/westernpacific/emergencies /covid-19
2. F. Zhou, T. Yu, R. Du, et al. Clinical course and risk factors for mortality of adult inpatients with COVID- 19 in Wuhan, China: a retrospective cohort study Lancet, 395 (10229) 2020: 1054-62.
3. Chen R, Liang W, Jiang M, et al. Medical Treatment Expert Group for COVID-19. Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China. Chest 2020.
4. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ 2020.
5. Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney international, 2020; 97: 829-38.
6. Wang Y, Liu S, Liu H, et al. SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19. Journal of hepatology, 2020; 73: 807-16.
7. Paliogiannis P, Mangoni AA, Cangemi M, et al. Serum albumin concentrations are associated with disease severity and outcomes in coronavirus 19 disease (COVID-19): a systematic review and metaanalysis. Clin Exp Med (2021).
8. Liu Y, Du X, Chen J, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect 2020.
9. Bellelli G, Rebora P, Valsecchi MG, et al. Frailty index predicts poor outcome in COVID-19 patients. Intensive Care Med 2020 May
10. Ji D, Zhang D, Xu J, et al. Prediction for progression risk in patients with COVID-19 pneumonia: The CALL Score. Clin Infect Dis 2020 Apr 9.
11. Cetinkal G, Kocas BB, Ser OS, et al. Assessment of the Modified CHA2DS2VASc Risk Score in Predicting mortality in Patients Hospitalized With COVID-19. The American journal of cardiology, 2020; 135: 143- 9.
12. Hu X, Deng H, Wang Y, et al. Predictive value of the prognostic nutritional index for the severity of coronavirus disease 2019. Nutrition. 2021 Apr; 84: 111-23.
13. Deng X, Liu B, Li J, et al. Blood biochemical characteristics of patients with coronavirus disease 2019 (COVID-19): a systemic review and metaanalysis. Clin Chem Lab Med. 2020 Jul 28; 58: 1172- 81.
14. Zhu W, He W, Guo L, et al. The HAS-BLED score for predicting major bleeding risk in anticoagulated patients with atrial fibrillation: a systematic review and meta-analysis. Clin Cardiol 2015; 38: 555–61.
15. Nazha B, Moussaly E, Zaarour M, et al. Hypoalbuminemia in colorectal cancer prognosis: nutritional marker or inflammatory surrogate? World J Gastrointest Surg. 2015; 7: 370–7.
16. Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factorbased approach: the euro heart survey on atrial fibrillation. Chest 2010; 137: 263−72.
17. Cappellini MD, Motta I. Anemia in clinical practice—definition and classification: does hemoglobin change with aging?. In Seminars in hematology. WB Saunders. 2015: 261-9.
18. Gauer R, Braun MM. Thrombocytopenia. American family physician, 2012; 85: 612-22.
19. Li P, Chen L, Liu Z, et al. Clinical features and short-term outcomes of elderly patients with COVID-19. International Journal of Infectious Diseases,2020; 97: 245-50.
20. Jin J. M, Bai P, He W, et al. Gender differences in patients with COVID-19: focus on severity and mortality. Frontiers in public health,2020; 8: 152.
21. Oyelade T, Alqahtani J, Canciani G. Prognosis of COVID-19 in Patients with Liver and Kidney Diseases: An Early Systematic Review and Meta- Analysis. Tropical medicine and infectious disease, 2020; 5: 80.
22. Imig JD, Ryan MJ. Immune and inflammatory role in renal disease. Compr. Physiol. 2013; 3: 957–76.
23. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan China, JAMA (2020)
24.Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020; 323: 1061−9.
25. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-
19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054−62.
26. Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial. 2004; 17: 432–7.
27. Feng Y , L ing Y , B ai T , e t a l. C OVID-19 with different severity: a multi-center study of clinical features. Am J Respir Crit Care Med. 2020; 201: 1380–8.
28. Zhang J, Wang X, Jia X, et al. Risk factors for disease severity, unimprovement, and mortality in COVID‐19 patients in Wuhan. Clin Microbiol Infect. 2020; 26: 767‐72.
29. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA. 2020; 323: 2052–9.
30.Moradi EV, Teimouri A, Rezaee R, et al. Increased age, neutrophil-to-lymphocyte ratio (NLR) and white blood cells count are associated with higher COVID-19 mortality. The American Journal of Emergency Medicine, 2021; 40: 11-4.
31. Bianchi VE. Role of nutrition on anemia in elderly. Clinical nutrition ESPEN, 2016; 11: 1-e11.
32. Hariyanto TI, Kurniawan A. Anemia is associated with severe coronavirus disease 2019 (COVID-19) infection. Transfusion and Apheresis Science 2020: 59.
33. Kucukcan NE, Kucukcan A. The relationship between hemogram parameters with clinical progress in COVID-19 patients. Dicle Tıp Dergisi, 2020; 47: 763-9.