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Published on: January 16, 2019
Intensive Care Infection Score (ICIS) is elevated in patients with moderate and severe COVID-19 in the early stages
Filip Vrbacky1, Ilona Fatorova1, Martin Blazek2
14th Department of Internal Medicine - Haematology, University Hospital Hradec Kralove and Faculty of Medicine Hradec Kralove, Charles University, Sokolska 581, Hradec Kralove, Czech Republic.
Insights
The Intensive Care Infection Score (ICIS) effectively predicts moderate to severe COVID-19. A score above 3.5 indicates a higher likelihood of severe disease progression in patients.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Clinical Diagnostics
Background:
- Coronavirus disease 2019 (COVID-19) presents a heterogeneous clinical course, posing risks to all age groups.
- Identifying early prognostic markers for COVID-19 is crucial due to its potential for severe complications.
- The Intensive Care Infection Score (ICIS), previously used for bacterial infection risk, was investigated for COVID-19 prognosis.
Purpose of the Study:
- To evaluate the performance of the Intensive Care Infection Score (ICIS) as a prognostic marker for COVID-19 disease severity.
- To determine if ICIS can reliably differentiate between mild and moderate/severe COVID-19 cases early in the disease course.
Main Methods:
- A cohort of 205 COVID-19 patients with respiratory symptoms and positive SARS-CoV-2 RT-PCR tests were analyzed.
- Patients were categorized into mild (no oxygen) and moderate/severe (oxygen therapy or death) groups.
- The predictive performance of ICIS for disease severity was assessed using metrics like Area Under the Curve (AUC) and Youden index.
Main Results:
- ICIS demonstrated the highest AUC (0.773) in predicting mild versus moderate/severe COVID-19.
- A cut-off value of ICIS = 3.5 yielded the highest Youden index (0.423).
- This cut-off achieved high specificity (77.6%) and positive predictive value (90.2%) for identifying moderate/severe disease.
Conclusions:
- The Intensive Care Infection Score (ICIS) is a reliable, cost-effective, and easily interpretable tool for early prognostication of COVID-19.
- An ICIS score greater than 3.5 effectively identifies patients at risk for a moderate to severe disease course.
- ICIS facilitates early identification, enabling timely clinical intervention for COVID-19 patients.
Background:
Coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus is still a very dangerous and life-threatening disease with an extremely heterogeneous course. Older patients and those with comorbidities are at increased risk of death from the disease but young patients can develop potentially lethal complications too. For those reasons, numerous recent studies focus on the analysis of markers associated with early assessment of COVID-19 prognosis. Previous publications provided evidence for the Intensive Care Infection Score (ICIS) as an easy to use tool to assess the risk for bacterial infection in ICU patients based on a combination of haematologic parameters. This study evaluated the performance of ICIS as a prognostic marker of stages of disease in COVID-19 patients.
Methods:
A total of 205 COVID-19 patients admitted to the University Hospital Hradec Kralove, Czech Republic, with symptoms of respiratory tract infection and a positive RT-PCR test for SARS-CoV-2 virus were enrolled in this study. Forty-nine patients developed mild COVID-19 symptoms (no oxygen therapy needed), 156 patients developed moderate or severe symptoms (supplemental oxygen therapy or death).
Results:
ICIS predicted the mild or moderate/severe course with the highest AUC (0.773). The cut-off value (ICIS = 3.5) was selected as the value with the highest Youden index (0.423). The cut-off value could predict a mild or moderate/severe course of the disease with the highest specificity (77.6%) and positive predictive value (90.2%) of all markers used in this study. Sensitivity was 64.7%.
Conclusion:
ICIS is a reliable, cheap, fast and simply interpretable score for the early identification of moderate/severe course of COVID-19 in an early stage of the disease. ICIS> 3 predicts a severe course of the disease with high specificity and positive predictive value.
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