Discriminatory accuracy of the SOFA score for determining clinical decompensation in patients presenting with COVID-19

Abstract

Introduction While the global dissemination of vaccines targeting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a decline in the incidence of infections, the case fatality rates have remained relative stable. A major objective of managing hospitalized patients with documented or suspected COVID-19 infection is the rapid identification of features associated with severe illness using readily available laboratory tests and clinical tools. The sequential organ failure assessment (SOFA) score is a validated tool to facilitate the identification of patients at risk of dying from sepsis. Purpose The aim of this study was to assess the discriminatory accuracy of the SOFA score in predicting clinical decompensation in patients hospitalized with COVID-19 infection. Methods We conducted a retrospective analysis at a three-hospital health system, comprised of one tertiary and two community hospitals, located in the Chicago metropolitan area. All patients had positive SARS-CoV-2 testing and were hospitalized for COVID-19 infection. The primary outcome was clinical decompensation, defined as the composite endpoint of death, ICU admission, or need for intubation. We utilized the most abnormal laboratory values observed during the admission to calculate the SOFA score. Receiver Operating Curves (ROC) were then constructed to determine the sensitivity and specificity of SOFA scores. Results Between March 1st and May 31st 2020, 1029 patients were included in our analysis with 367 patients meeting the study endpoint. The median SOFA score was 2.0 IQR (Q1, Q3 1,4) for the entire cohort. Patients who had in-hospital mortality had a median SOFA score of 4.0 (Q1,Q3 3,7). In patients that met the primary composite endpoint, the median SOFA score was 3.0, IQR (Q1, Q3 2,6). The ROC was 0.776 (95% CI 0.746–0.806, p<0.01). Conclusion The SOFA score demonstrates strong discriminatory accuracy for prediction of clinical decompensation in patients presenting with COVID-19 at our urban hospital system. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Loyola University Medical Center

Development and Internal Validation of a New Prognostic Model Powered to Predict 28-Day All-Cause Mortality in ICU COVID-19 Patients—The COVID-SOFA Score

“…Regarding hematological changes induced by SARS-CoV-2, these were similar with previously reported data, with lymphopenia, neutrophilia and higher D-dimer values being associated with poor outcome [ 19 , 20 ]. The SOFA score values in COVID-19 patients admitted to ICU have important variations between studies [ 19 ], depending on: (i) the selected patients, (ii) the moment of measurement (e.g., ICU admission, before endotracheal intubation, repeated measurements), and (iii) missing data and how points were assigned [ 21 , 22 , 23 , 24 , 25 ]. In our study, the median SOFA score at ICU admission was significantly different depending on the level of respiratory support required.…”

“…This suggests that the COVID-SOFA score is better to be used as a repetitive score, as recommended with the original SOFA score [ 36 ]. Lastly, dynamic changes in NLR [ 19 ] and the SOFA score [ 23 , 24 ] are associated with disease severity and death.…”