BMC Nephrology (Oct 2023)

Temporal validation of the MMCD score to predict kidney replacement therapy and in-hospital mortality in COVID-19 patients

  • Vanessa das Graças José Ventura,
  • Polianna Delfino Pereira,
  • Magda Carvalho Pires,
  • Alisson Alves Asevedo,
  • Alzira de Oliveira Jorge,
  • Ana Carolina Pitanga dos Santos,
  • André Soares de Moura Costa,
  • Angélica Gomides dos Reis Gomes,
  • Beatriz Figueiredo Lima,
  • Bruno Porto Pessoa,
  • Christiane Corrêa Rodrigues Cimini,
  • Claudio Moisés Valiense de Andrade,
  • Daniela Ponce,
  • Danyelle Romana Alves Rios,
  • Elayne Crestani Pereira,
  • Euler Roberto Fernandes Manenti,
  • Evelin Paola de Almeida Cenci,
  • Felício Roberto Costa,
  • Fernando Anschau,
  • Fernando Graça Aranha,
  • Flavia Maria Borges Vigil,
  • Frederico Bartolazzi,
  • Gabriella Genta Aguiar,
  • Genna Maira Santos Grizende,
  • Joanna d’Arc Lyra Batista,
  • João Victor Baroni Neves,
  • Karen Brasil Ruschel,
  • Letícia do Nascimento,
  • Lucas Moyses Carvalho de Oliveira,
  • Luciane Kopittke,
  • Luís César de Castro,
  • Manuela Furtado Sacioto,
  • Marcelo Carneiro,
  • Marcos André Gonçalves,
  • Maria Aparecida Camargos Bicalho,
  • Mônica Aparecida da Paula Sordi,
  • Natália da Cunha Severino Sampaio,
  • Pedro Gibson Paraíso,
  • Rochele Mosmann Menezes,
  • Silvia Ferreira Araújo,
  • Vivian Costa Morais de Assis,
  • Katia de Paula Farah,
  • Milena Soriano Marcolino

DOI
https://doi.org/10.1186/s12882-023-03341-9
Journal volume & issue
Vol. 24, no. 1
pp. 1 – 12

Abstract

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Abstract Background Acute kidney injury has been described as a common complication in patients hospitalized with COVID-19, which may lead to the need for kidney replacement therapy (KRT) in its most severe forms. Our group developed and validated the MMCD score in Brazilian COVID-19 patients to predict KRT, which showed excellent performance using data from 2020. This study aimed to validate the MMCD score in a large cohort of patients hospitalized with COVID-19 in a different pandemic phase and assess its performance to predict in-hospital mortality. Methods This study is part of the “Brazilian COVID-19 Registry”, a retrospective observational cohort of consecutive patients hospitalized for laboratory-confirmed COVID-19 in 25 Brazilian hospitals between March 2021 and August 2022. The primary outcome was KRT during hospitalization and the secondary was in-hospital mortality. We also searched literature for other prediction models for KRT, to assess the results in our database. Performance was assessed using area under the receiving operator characteristic curve (AUROC) and the Brier score. Results A total of 9422 patients were included, 53.8% were men, with a median age of 59 (IQR 48–70) years old. The incidence of KRT was 8.8% and in-hospital mortality was 18.1%. The MMCD score had excellent discrimination and overall performance to predict KRT (AUROC: 0.916 [95% CI 0.909–0.924]; Brier score = 0.057). Despite the excellent discrimination and overall performance (AUROC: 0.922 [95% CI 0.914–0.929]; Brier score = 0.100), the calibration was not satisfactory concerning in-hospital mortality. A random forest model was applied in the database, with inferior performance to predict KRT requirement (AUROC: 0.71 [95% CI 0.69–0.73]). Conclusion The MMCD score is not appropriate for in-hospital mortality but demonstrates an excellent predictive ability to predict KRT in COVID-19 patients. The instrument is low cost, objective, fast and accurate, and can contribute to supporting clinical decisions in the efficient allocation of assistance resources in patients with COVID-19.

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