CHA2DS2-VASc score as a predictor of clinical outcomes in hospitalized patients with and without chronic kidney disease

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Abstract
Background: High CHA 2 DS 2 -VASc score (Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65–74 and Sex category) was associated with adverse clinical outcomes in different settings. The aim of the present study was to evaluate the association between CHA 2 DS 2 -VASc score and R 2 CHA 2 DS 2 -VASc score (which includes renal impairment) with in-hospital mortality and length of hospital stay in patients hospitalized in an internal medicine ward. Methods: We enrolled 983 consecutive patients admitted during 3 years in an internal medicine ward. R 2 CHA 2 DS 2 -VASc score was calculated by adding 2 points to CHA 2 DS 2 -VASc for the presence of chronic kidney disease (CKD), defined according to K-DOQI. The primary outcome was a composite of all-cause mortality and length of hospital stay > 10 days. Results: Patients with CKD stages 3–5 presented with increased CHA 2 DS 2 -VASc vs stages 1–2 ( p < 0.001). The composite outcome occurred in 47.3% of inpatients. Multivariable linear logistic regression analyses adjusted for presence of infectious diseases and cancer, with the occurrence of composite outcome showed an adjusted OR of 1.349 (95% CI 1.248–1.462) and 1.254 (95% CI 1.179–1.336) for CHA 2 DS 2 -VASc and R 2 CHA 2 DS 2 -VASc scores, respectively. No differences were found in the association between CHA 2 DS 2 -VASc and R 2 CHA 2 DS 2 -VASc scores with the composite outcome (AUC 0.631 vs 0.630), and furthermore, adding the presence/absence of infectious diseases during hospitalization and positive cancer history to the models increased the AUC (0.667 and 0.663). Conclusions: Incrementally higher CHA 2 DS 2 -VASc score is associated with increased length of hospital stay and mortality in patients hospitalized in an internal medicine ward, regardless of the presence of CKD. Graphical
Funding Information
  • Università degli Studi di Roma La Sapienza

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