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. 2021 Nov 18;11(11):e053281. doi: 10.1136/bmjopen-2021-053281

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© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Receiver operating characteristic (ROC) curves comparing discriminant power (A) of COVID-19 Vulnerability Score (CVS), Charlson Comorbidity Index (CCI) and Multisource Comorbidity Score (MCS) from the derivation set (B) of CVS from several validation sets. Derivation set (left box) was based on the cohort of 7 655 502 beneficiaries of the Lombardy Region Health Service for at least 2 years, who on 21 February 2020 were alive, aged between 18 and 79 years and did not reside in a nursing home. During the first epidemic wave (until June 2020), this cohort experienced 9160 severe (intensive care unit admitted and mechanically ventilated via intubation) and/or fatal outcomes. Validation sets (right box) were based on: (1) 7 575 924 resident in Lombardy whom observation started on 1 July 2020 and who experienced 2822 severe/fatal outcomes within 31 December 2020; (2) 92 267, 1 110 570, 3 012 754 and 3 649 518 beneficiaries of Valle d’Aosta, Marche, Puglia and Sicily regional health services, whom observation started on 1 March 2020 and who, respectively, experienced 173, 542, 1953 and 1541 severe/fatal outcomes within 31 December 2020.