The Usefulness of the COVID-GRAM Score in Predicting the Outcomes of Study Population with COVID-19

The COVID-GRAM is a clinical risk rating score for predicting the prognosis of hospitalized COVID-19 infected patients. Our study aimed to evaluate the use of the COVID-GRAM score in patients with COVID-19 based on the data from the COronavirus in the LOwer Silesia (COLOS) registry. The study group...

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Published in:	International journal of environmental research and public health Vol. 19; no. 19; p. 12537
Main Authors:	Sebastian, Agata, Madziarski, Marcin, Madej, Marta, Proc, Krzysztof, Szymala-Pędzik, Małgorzata, Żórawska, Joanna, Gronek, Michał, Morgiel, Ewa, Kujawa, Krzysztof, Skarupski, Marek, Trocha, Małgorzata, Rola, Piotr, Gawryś, Jakub, Letachowicz, Krzysztof, Doroszko, Adrian, Adamik, Barbara, Kaliszewski, Krzysztof, Kiliś-Pstrusińska, Katarzyna, Matera-Witkiewicz, Agnieszka, Pomorski, Michał, Protasiewicz, Marcin, Sokołowski, Janusz, Jankowska, Ewa Anita, Madziarska, Katarzyna
Format:	Journal Article
Language:	English
Published:	Switzerland MDPI AG 01-10-2022 MDPI
Subjects:	Anti-Bacterial Agents Antibiotics Blood pressure C-Reactive Protein Calcium-binding protein Chi-square test Chronic illnesses Chronic obstructive pulmonary disease Complications Congestive heart failure Coronary artery disease Coronaviruses COVID-19 COVID-19 - epidemiology Diabetes mellitus Dialysis Disease Ethnicity Flutter Health risks Heart diseases Heart failure Hospitalization Hospitals Humans Hyperglycemia Hypertension Intensive care Kidney diseases Laboratories Leukocytosis Lung diseases Medical prognosis Mortality Neurological complications Obstructive lung disease Oxygen Patients Pneumonia Population studies Procalcitonin Prognosis Renal failure Retrospective Studies Risk Risk groups SARS-CoV-2 Statistical analysis Survival Troponin Variance analysis Ventilators COVID-19 mortality GRAM score
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Summary:	The COVID-GRAM is a clinical risk rating score for predicting the prognosis of hospitalized COVID-19 infected patients. Our study aimed to evaluate the use of the COVID-GRAM score in patients with COVID-19 based on the data from the COronavirus in the LOwer Silesia (COLOS) registry. The study group (834 patients of Caucasian patients) was retrospectively divided into three arms according to the risk achieved on the COVID-GRAM score calculated at the time of hospital admission (between February 2020 and July 2021): low, medium, and high risk. The Omnibus chi-square test, Fisher test, and Welch ANOVA were used in the statistical analysis. Post-hoc analysis for continuous variables was performed using Tukey's correction with the Games-Howell test. Additionally, the ROC analysis was performed over time using inverse probability of censorship (IPCW) estimation. The GRAM-COVID score was estimated from the time-dependent area under the curve (AUC). Most patients (65%) had a low risk of complications on the COVID-GRAM scale. There were 113 patients in the high-risk group (13%). In the medium- and high-risk groups, comorbidities occurred statistically significantly more often, e.g., hypertension, diabetes, atrial fibrillation and flutter, heart failure, valvular disease, chronic kidney disease, and obstructive pulmonary disease (COPD), compared to low-risk tier subjects. These individuals were also patients with a higher incidence of neurological and cardiac complications in the past. Low saturation of oxygen values on admission, changes in C-reactive protein, leukocytosis, hyperglycemia, and procalcitonin level were associated with an increased risk of death during hospitalization. The troponin level was an independent mortality factor. A change from low to medium category reduced the overall survival probability by more than 8 times and from low to high by 25 times. The factor with the strongest impact on survival was the absence of other diseases. The medium-risk patient group was more likely to require dialysis during hospitalization. The need for antibiotics was more significant in the high-risk group on the GRAM score. The COVID-GRAM score corresponds well with total mortality. The factor with the strongest impact on survival was the absence of other diseases. The worst prognosis was for patients who were unconscious during admission. Patients with higher COVID-GRAM score were significantly less likely to return to full health during follow-up. There is a continuing need to develop reliable, easy-to-adopt tools for stratifying the course of SARS-CoV-2 infection.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 These authors contributed equally to this work.
ISSN:	1660-4601 1661-7827 1660-4601
DOI:	10.3390/ijerph191912537