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Background:  Endothelial Activation and Stress Index (EASIX) predict death in patients undergoing allogeneic hematopoietic stem cell transplantation who develop endothelial complications. Because coronavirus disease 2019 (COVID-19) patients also have coagulopathy and endotheliitis, we aimed to assess whether EASIX predicts death within 28 days in hospitalized COVID-19 patients.   Methods:  We performed a retrospective study on COVID-19 patients from two different cohorts [derivation ( n  = 1,200 patients) and validation ( n  = 1,830 patients)]. The endpoint was death within 28 days. The main factors were EASIX [(lactate dehydrogenase  *  creatinine)/thrombocytes] and aEASIX-COVID (EASIX  *  age), which were log 2 -transformed for analysis.   Results:  Log 2 -EASIX and log 2 -aEASIX-COVID were independently associated with an increased risk of death in both cohorts ( p  < 0.001). Log 2 -aEASIX-COVID showed a good predictive performance for 28-day mortality both in the derivation cohort (area under the receiver-operating characteristic = 0.827) and in the validation cohort (area under the receiver-operating characteristic = 0.820), with better predictive performance than log 2 -EASIX ( p  < 0.001). For log 2  aEASIX-COVID, patients with low/moderate risk (<6) had a 28-day mortality probability of 5.3% [95% confidence interval (95% CI) = 4–6.5%], high (6–7) of 17.2% (95% CI = 14.7–19.6%), and very high (>7) of 47.6% (95% CI = 44.2–50.9%). The cutoff of log 2  aEASIX-COVID = 6 showed a positive predictive value of 31.7% and negative predictive value of 94.7%, and log 2  aEASIX-COVID = 7 showed a positive predictive value of 47.6% and negative predictive value of 89.8%.   Conclusion:  Both EASIX and aEASIX-COVID were associated with death within 28 days in hospitalized COVID-19 patients. However, aEASIX-COVID had significantly better predictive performance than EASIX, particularly for discarding death. Thus, aEASIX-COVID could be a reliable predictor of death that could help to manage COVID-19 patients.

frontiers in medicine

Age-Adjusted Endothelial Activation and Stress Index for Coronavirus Disease 2019 at Admission Is a Reliable Predictor for 28-Day Mortality in Hospitalized Patients With Coronavirus Disease 2019