Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 22, Issue 2, Pages 610-625Publisher
ELSEVIER SCIENCE INC
DOI: 10.1111/ajt.16807
Keywords
clinical research; practice; complication; infectious; health services and outcomes research; infection and infectious agents; viral; infectious disease; kidney transplantation; nephrology
Categories
Funding
- Novartis Pharma Brazil
- Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior - Brasil (CAPES) [88881.507066/2020-01]
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This study used data from the Brazilian kidney transplant COVID-19 study to develop a prediction score for stratifying COVID-19 risk in kidney transplant recipients. The prediction score included factors such as age, hypertension, cardiovascular disease, body mass index, symptoms, and medication use.
This analysis, using data from the Brazilian kidney transplant (KT) COVID-19 study, seeks to develop a prediction score to assist in COVID-19 risk stratification in KT recipients. In this study, 1379 patients (35 sites) were enrolled, and a machine learning approach was used to fit models in a derivation cohort. A reduced Elastic Net model was selected, and the accuracy to predict the 28-day fatality after the COVID-19 diagnosis, assessed by the area under the ROC curve (AUC-ROC), was confirmed in a validation cohort. The better calibration values were used to build the applicable ImAgeS score. The 28-day fatality rate was 17% (n = 235), which was associated with increasing age, hypertension and cardiovascular disease, higher body mass index, dyspnea, and use of mycophenolate acid or azathioprine. Higher kidney graft function, longer time of symptoms until COVID-19 diagnosis, presence of anosmia or coryza, and use of mTOR inhibitor were associated with reduced risk of death. The coefficients of the best model were used to build the predictive score, which achieved an AUC-ROC of 0.767 (95% CI 0.698-0.834) in the validation cohort. In conclusion, the easily applicable predictive model could assist health care practitioners in identifying non-hospitalized kidney transplant patients that may require more intensive monitoring.
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