• Marco Zuin, Roberto Ferrari, Gabriele Guardigli, Michele Malagù, Francesco Vitali, Ottavio Zucchetti, Emanuele D'Aniello, Luca Di Ienno, Federico Gibiino, Paolo Cimaglia, Daniele Grosseto, Alessandro Corzani, Marcello Galvani, Paolo Ortolani, Andrea Rubboli, Gianfranco Tortorici, Gianni Casella, Biagio Sassone, Alessandro Navazio, Luca Rossi, Daniela Aschieri, Roberto Mezzanotte, Marco Manfrini, and Matteo Bertini.
• Unit of Cardiology, Department of Translational Medicine, Centro Cardiologico, Universita' degli studi di Ferrara, Via Aldo Moro, 8, 44124, Cona, Ferrara, Italy.
• Intern Emerg Med. 2024 Apr 23.

AbstractWe aimed to develop and validate a COVID-19 specific scoring system, also including some ECG features, to predict all-cause in-hospital mortality at admission. Patients were retrieved from the ELCOVID study (ClinicalTrials.gov identifier: NCT04367129), a prospective, multicenter Italian study enrolling COVID-19 patients between May to September 2020. For the model validation, we randomly selected two-thirds of participants to create a derivation dataset and we used the remaining one-third of participants as the validation set. Over the study period, 1014 hospitalized COVID-19 patients (mean age 74 years, 61% males) met the inclusion criteria and were included in this analysis. During a median follow-up of 12 (IQR 7-22) days, 359 (35%) patients died. Age (HR 2.25 [95%CI 1.72-2.94], p < 0.001), delirium (HR 2.03 [2.14-3.61], p = 0.012), platelets (HR 0.91 [0.83-0.98], p = 0.018), D-dimer level (HR 1.18 [1.01-1.31], p = 0.002), signs of right ventricular strain (RVS) (HR 1.47 [1.02-2.13], p = 0.039) and ECG signs of previous myocardial necrosis (HR 2.28 [1.23-4.21], p = 0.009) were independently associated to in-hospital all-cause mortality. The derived risk-scoring system, namely EL COVID score, showed a moderate discriminatory capacity and good calibration. A cut-off score of ≥ 4 had a sensitivity of 78.4% and 65.2% specificity in predicting all-cause in-hospital mortality. ELCOVID score represents a valid, reliable, sensitive, and inexpensive scoring system that can be used for the prognostication of COVID-19 patients at admission and may allow the earlier identification of patients having a higher mortality risk who may be benefit from more aggressive treatments and closer monitoring.© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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