A novel severity score to predict inpatient mortality in COVID-19 patients

Abstract

COVID-19 is commonly mild and self-limiting, but in a considerable portion of patients the disease is severe and fatal. Determining which patients are at high risk of severe illness or mortality is essential for appropriate clinical decision making. We propose a novel severity score specifically for COVID-19 to help predict disease severity and mortality. 4711 patients with confirmed SARS-CoV-2 infection were included. We derived a risk model using the first half of the cohort (n = 2355 patients) by logistic regression and bootstrapping methods. The discriminative power of the risk model was assessed by calculating the area under the receiver operating characteristic curves (AUC). The severity score was validated in a second half of 2356 patients. Mortality incidence was 26.4% in the derivation cohort and 22.4% in the validation cohort. A COVID-19 severity score ranging from 0 to 10, consisting of age, oxygen saturation, mean arterial pressure, blood urea nitrogen, C-Reactive protein, and the international normalized ratio was developed. A ROC curve analysis was performed in the derivation cohort achieved an AUC of 0.824 (95% CI 0.814–0.851) and an AUC of 0.798 (95% CI 0.789–0.818) in the validation cohort. Furthermore, based on the risk categorization the probability of mortality was 11.8%, 39% and 78% for patient with low (0–3), moderate (4–6) and high (7–10) COVID-19 severity score. This developed and validated novel COVID-19 severity score will aid physicians in predicting mortality during surge periods.

Prognosis Score System to Predict Survival for COVID-19 Cases: a Korean Nationwide Cohort Study

“…However, the study did not analyze survival and death among patients with a confirmed COVID-19 diagnosis. In addition to studies attempting to predict death in patients with COVID-19, other studies have focused on severity index to predict severe or critical cases [ 10 , 28 - 31 ]. More recently, a machine learning–based warning system for mortality risk prediction of patients with COVID-19 was reported, and timely risk stratification using multiple laboratory and clinical factors was improved [ 32 ].…”

Safety and effectiveness of high-dose vitamin C in patients with COVID-19: a randomized open-label clinical trial

“…Secondary endpoints were determined as improvements in SpO 2 and vital signs as well as the general wellbeing of the patient. Severity score was calculated based on the scoring system suggested by Altschul et al for prediction of inpatient mortality in COVID-19 patients [21]. Based on this scoring system, the higher the score of the patient, the higher the odds of inpatient mortality.…”

The utility of HRCT in the initial diagnosis of COVID-19 pneumonia—An Indian perspective

“…Additional prognostic information provided with the CT severity index means it can be used as an important metric for a triage system to determine who needs to be admitted/home quarantined and so on. [ 16 ] Easy scalability with high throughput, the possibility of remote diagnosis by leveraging teleradiology facilities mean that the HRCT chest is a very useful tool for initial diagnosis. Additional information for other causes of breathlessness (e.g., cardiomegaly/pleural effusions/pulmonary edema and even malignancies) may also be available.…”