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Predicting In-Hospital Mortality in COVID-19 Older Patients with Specifically Developed Scores
Marcello Covino1, Giuseppe De Matteis2, Maria Livia Burzo2
1Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Insights
The ISARIC-4C and COVID-GRAM scores best predicted in-hospital death for older COVID-19 patients. The National Early Warning Score (NEWS) also showed similar effectiveness, making it a viable option for this demographic.
Area of Science:
- Medical research
- Clinical epidemiology
- Infectious disease
Background:
- Several scoring systems exist for COVID-19 patient risk stratification.
- Accurate risk assessment is crucial for managing severe cases.
Purpose of the Study:
- To compare the predictive performance of three COVID-19 specific scores against a general early warning score.
- To identify the most effective tool for stratifying risk in older COVID-19 patients.
Main Methods:
- Retrospective observational study of 210 COVID-19 patients aged 60+ admitted to the Emergency Department.
- Comparison of International Severe Acute Respiratory Infection Consortium Clinical Characterization Protocol-Coronavirus Clinical Characterization Consortium (ISARIC-4C) score, COVID-GRAM Critical Illness Risk Score (COVID-GRAM), quick COVID-19 Severity Index (qCSI), and National Early Warning Score (NEWS).
- Primary endpoint: all-cause in-hospital mortality.
Main Results:
- All evaluated scores demonstrated good predictive value for in-hospital death.
- ISARIC-4C (AUROC 0.799) and COVID-GRAM (AUROC 0.785) showed the highest predictive accuracy.
- NEWS (AUROC 0.764) and qCSI (AUROC 0.749) also performed well, with no statistically significant differences between scores.
Conclusions:
- ISARIC-4C and COVID-GRAM are effective for risk stratification of older COVID-19 patients upon Emergency Department admission.
- The qCSI offers similar efficacy with fewer variables.
- The widely used NEWS demonstrates comparable performance and may be suitable for this patient group.
Background/Objectives:
Several scoring systems have been specifically developed for risk stratification in COVID-19 patients.
Design:
We compared, in a cohort of confirmed COVID-19 older patients, three specifically developed scores with a previously established early warning score. Main endpoint was all causes in-hospital death.
Setting:
This is a single-center, retrospective observational study, conducted in the Emergency Department (ED) of an urban teaching hospital, referral center for COVID-19.
Participants:
We reviewed the clinical records of the confirmed COVID-19 patients aged 60 years or more consecutively admitted to our ED over a 6-week period (March 1st to April 15th, 2020). A total of 210 patients, aged between 60 and 98 years were included in the study cohort.
Measurements:
International Severe Acute Respiratory Infection Consortium Clinical Characterization Protocol-Coronavirus Clinical Characterization Consortium (ISARIC-4C) score, COVID-GRAM Critical Illness Risk Score (COVID-GRAM), quick COVID-19 Severity Index (qCSI), National Early Warning Score (NEWS).
Results:
Median age was 74 (67-82) and 133 (63.3%) were males. Globally, 42 patients (20.0%) deceased. All the score evaluated showed a fairly good predictive value with respect to in-hospital death. The ISARIC-4C score had the highest area under ROC curve (AUROC) 0.799 (0.738-0.851), followed by the COVID-GRAM 0.785 (0.723-0.838), NEWS 0.764 (0.700-0.819), and qCSI 0.749 (0.685-0.806). However, these differences were not statistical significant.
Conclusion:
Among the evaluated scores, the ISARIC-4C and the COVID-GRAM, calculated at ED admission, had the best performance, although the qCSI had similar efficacy by evaluating only three items. However, the NEWS, already widely validated in clinical practice, had a similar performance and could be appropriate for older patients with COVID-19.
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