The Effect of Host Risk Factors in Determining the Mortality in Covid 19
Pneumonia and a Novel Covid-19 Mortality Index: Co-AMSCA
Abstract
Aim:The purpose of this study was to determine the host risk factors
associated with mortality in COVID-19 patients who are hospitalized for
pneumonia, and also, to find a COVID-19 mortality score based on these.
Methods:All patients diagnosed as confirmed or probable COVID-19
pneumonia whom hospitalised in our Chest Diseases Education and Research
Hospital between March 11, 2020 and October 1,2020 were enrolled. The
optimal cut-off values, sensitivity and specificity values and odds
ratios to be used in mortality prediction of the novel scoring system
created from these parameters were calculated by ROC analysis according
to the area under the curve and Youden index. Results:Over 422 patients
(n: 51 mortal, n: 371 survivors) univariate regression analysis showed
that age, male gender, smoking, comorbidity, and using ACE inhibitor
were prognostic host risk factors for COVID-19-related mortality. Using
this analysis, a novel scoring model Co-AMSCA (Age, Male, Smoking
history, Comorbidity, ACE inh)was established. The cut-off value of this
scoring system (including only host risk factors), which determines the
mortality risk in patients, was 3.5 points with 88.4% sensitivity and
65.5 % specificity (AUC = 0.761, 95% CI 0.697-0.826, P <
.001) (Figure 1). The mortality risk in patients with a Co-AMSCA
mortality score above 3.5 points was 7.8 times higher than patients with
lower than 3.5 (OR= 7.8; P < .001).In multivariate logistic
regression analysis, older age and smoking (smoker/ex-smoker) were found
to be important risk factors for mortality (OR = 12.09; 95% CI
2,564-57,054 P =0.004 and OR = 3.1; 95% CI 1,381-7,295; P =
0.007,respectively). Counclusion:We created a simple mortality score,
which is easily calculated and does not require laboratory and time.This
study showed that by using Co-AMSCA mortality score that has only host
risk factors achieved a prediction of mortality in COVID-19 patients who
are hospitalized for pneumonia.