TY  - JOUR
VL  - 11
JF  - Frontiers in Medicine
PB  - FRONTIERS MEDIA SA
UR  - http://dx.doi.org/10.3389/fmed.2024.1293431
Y1  - 2024///
ID  - discovery10190215
N1  - © 2024 the Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/).
TI  - Development and validation of a prediction score for failure to casirivimab/imdevimab in hospitalized patients with COVID-19 pneumonia
AV  - public
KW  - casirivimab/imdevimab
KW  -  COVID-19
KW  -  mechanical ventilation
KW  -  mortality
KW  -  prediction score
KW  -  SARS-CoV-2
N2  - INTRODUCTION: Casirivimab and imdevimab (CAS/IMV) are two non-competing, high-affinity human IgG1 anti-SARS-CoV-2 monoclonal antibodies, that showed a survival benefit in seronegative hospitalized patients with COVID-19. This study aimed to estimate the day-28 risk of mechanical ventilation (MV) and death in individuals hospitalized for severe COVID-19 pneumonia and receiving CAS/IMV. Additionally, it aimed to identify variables measured at the time of hospital admission that could predict these outcomes and derive a prediction algorithm. METHODS: This is a retrospective, observational cohort study conducted in 12 hospitals in Italy. Adult patients who were consecutively hospitalized from November 2021 to February 2022 receiving CAS/IMV were included. A multivariable logistic regression model was used to identify predictors of MV or death by day 28 from treatment initiation, and ?-coefficients from the model were used to develop a risk score that was derived by means of leave-one-out internal cross-validation (CV), external CV, and calibration. Secondary outcome was mortality. RESULTS: A total of 480 hospitalized patients in the training set and 157 patients in the test set were included. By day 28, 36 participants (8%) underwent MV and 28 died (6%) for a total of 58 participants (12%) experiencing the composite primary endpoint. In multivariable analysis, four factors [age, PaO2/FiO2 ratio, lactate dehydrogenase (LDH), and platelets] were independently associated with the risk of MV/death and were used to generate the proposed risk score. The accuracy of the score in the area under the curve (AUC) was 0.80 and 0.77 in internal validation and test for the composite endpoint and 0.87 and 0.86 for death, respectively. The model also appeared to be well calibrated with the raw data. CONCLUSION: The mortality risk reported in our study was lower than that previously reported. Although CAS/IMV is no longer used, our score might help in identifying which patients are not likely to benefit from monoclonal antibodies and may require alternative interventions.
A1  - Cozzi-Lepri, Alessandro
A1  - Borghi, Vanni
A1  - Rotundo, Salvatore
A1  - Mariani, Bianca
A1  - Ferrari, Anna
A1  - Del Borgo, Cosmo
A1  - Bai, Francesca
A1  - Colletti, Pietro
A1  - Miraglia, Piermauro
A1  - Torti, Carlo
A1  - Cattelan, Anna Maria
A1  - Cenderello, Giovanni
A1  - Berruti, Marco
A1  - Tascini, Carlo
A1  - Parruti, Giustino
A1  - Coladonato, Simona
A1  - Gori, Andrea
A1  - Marchetti, Giulia
A1  - Lichtner, Miriam
A1  - Coppola, Luigi
A1  - Sorace, Chiara
A1  - D'Abramo, Alessandra
A1  - Mazzotta, Valentina
A1  - Guaraldi, Giovanni
A1  - Franceschini, Erica
A1  - Meschiari, Marianna
A1  - Sarmati, Loredana
A1  - Antinori, Andrea
A1  - Nicastri, Emanuele
A1  - Mussini, Cristina
EP  - 9
ER  -