Background and Objectives: Clinical risk scores were poorly examined in kidney transplant recipients (KTR) with COVID-19. Materials and Methods: This observational study compared the association and discrimination of clinical risk scores (MEWS, qCSI, VACO, PSI/PORT, CCI, MuLBSTA, ISTH-DIC, COVID-GRAM and 4C) with 30-day mortality in 65 hospitalized KTRs with COVID-19. Cox regression was used to derive hazard ratios (HR) and 95% confidence intervals (95% CI), and discrimination was assessed by Harrell's C. Results: A significant association with 30-day mortality was demonstrated for MEWS (HR 1.65 95% CI 1.21-2.25, p = 0.002); qCSI (HR 1.32 95% CI 1.15-1.52, p < 0.001); PSI/PORT (HR 1.04 95% CI 1.02-1.07, p = 0.001); CCI (HR 1.79 95% CI 1.13-2.83, p = 0.013); MuLBSTA (HR 1.31 95% CI 1.05-1.64, p = 0.017); COVID-GRAM (HR 1.03 95% CI 1.01-1.06, p = 0.004); and 4C (HR 1.79 95% CI 1.40-2.31, p < 0.001). After multivariable adjustment, significant association persisted for qCSI (HR 1.33 95% CI 1.11-1.59, p = 0.002); PSI/PORT (HR 1.04 95% CI 1.01-1.07, p = 0.012); MuLBSTA (HR 1.36 95% CI 1.01-1.85, p = 0.046); and 4C Mortality Score (HR 1.93 95% CI 1.45-2.57, p < 0.001) risk scores. The best discrimination was observed with the 4C score (Harrell's C = 0.914). Conclusions: Risk scores such as qCSI, PSI/PORT and 4C showed the best association with 30-day mortality amongst KTRs with COVID-19.
Keywords: COVID-19; kidney transplant recipients; mortality; risk score.