[Performance of prognostic scores during the first and second waves of COVID-19 pneumonia]

Introduction: Risk stratification in COVID-19 is crucial. We aimed to evaluate and compare the performance of prognostic scores for their respective endpoints (mortality or progression to severity) in hospitalized patients during the first and second pandemic waves in Córdoba, Argentina. Materials and methods: A retrospective cohort study was conducted in a tertiary care hospital. We included adults with COVID-19 pneumonia, comparing outcomes between the first (Mar/2020-Feb/2021) and second wave (Mar/2021-Dec/2021). The discrimination of each score for its specific endpoint (28/30-day mortality or progression) was assessed by ROC analysis. Results: Of 1176 patients, 30-day mortality was lower in the second wave (16.9% vs 28.8%; p<0.001). The 4C Score and PSI/PORT showed the best and most stable discrimination for mortality (AUC ~0.84) across both waves. In patients without initial severe disease, the CALL Score demonstrated acceptable discrimination for predicting progression to severity (AUC 1st wave: 0.71; 2nd wave: 0.67). Conclusion: Prognostic scores for mortality (4C, PSI/PORT) and for progression (CALL Score) maintained their clinical validity across different pandemic waves. They proved to be robust tools for risk stratification according to their respective endpoints, despite changes in patient profiles and vaccination status.