Predictive Performance of SAPS-3, SOFA Score, and Procalcitonin for Hospital Mortality in COVID-19 Viral Sepsis: A...

Objective: To evaluate the prognostic utility of the Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score 3 (SAPS 3) in COVID-19 patients and assess whether incorporating C-reactive protein (CRP), procalcitonin, lactate, and lactate dehydrogenase (LDH) enhances their predictive accuracy. Methods: Single-center, observational, cohort study. We analyzed a database of adult ICU patients with severe or critical COVID-19 treated at a large academic center. We used binary logistic regression for all analyses. We assessed the predictive performance of SAPS 3 and SOFA scores within 24 h of admission, individually and in combination with serum lactate, LDH, CRP, and procalcitonin. We examined the independent association of these biomarkers with hospital mortality. We evaluated discrimination using the C-statistic and determined clinical utility with decision curve analysis. Results: We included 1395 patients, 66% of whom required mechanical ventilation, and 59.7% needed vasopressor support. Patients who died (39.7%) were significantly older (61.1 ± 15.9 years vs. 50.1 ± 14.5 years, p < 0.001) and had more comorbidities than survivors. Among the biomarkers, only procalcitonin was independently associated with higher mortality in the multivariable analysis, in a non-linear pattern. The AUROC for predicting hospital mortality was 0.771 (95% CI: 0.746-0.797) for SAPS 3 and 0.781 (95% CI: 0.756-0.805) for the SOFA score. A model incorporating the SOFA score, age, and procalcitonin demonstrated high AUROC of 0.837 (95% CI: 0.816-0.859). These associations with the SOFA score showed greater clinical utility. Conclusions: The SOFA score may aid clinical decision-making, and incorporating procalcitonin and age could further enhance its prognostic utility.