Evaluation and Comparison of the Predictive Value of 4C Mortality Score, NEWS, and CURB-65 in Poor Outcomes in COVID-19 Patients: A Retrospective Study from a Single Center in Romania

Abstract

To date, the COVID-19 pandemic has caused millions of deaths across the world. Prognostic scores can improve the clinical management of COVID-19 diagnosis and treatment. The objective of this study was to assess the predictive role of 4C Mortality, CURB-65, and NEWS in COVID-19 mortality among the Romanian population. A single-center, retrospective, observational study was conducted on patients with reverse transcriptase-polymerase chain reaction (RT-PCR)-proven COVID-19 admitted to the Municipal Emergency Clinical Hospital of Timisoara, Romania, between 1 October 2020 and 15 March 2021. Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were performed to determine the discrimination accuracy of the three scores. The mean values of the risk scores were higher in the non-survivors group (survivors group vs. non-survivors group: 8 vs. 15 (4C Mortality Score); 3 vs. 8.5 (NEWS); 1 vs. 3 (CURB-65)). In terms of mortality risk prediction, the NEWS performed best, with an AUC of 0.86, and the CURB-65 score performed poorly, with an AUC of 0.80. CURB-65, NEWS, and 4C Mortality scores were significant mortality predictors in the analysis, with acceptable calibration. Among the scores assessed in our study, NEWS had the highest performance in predicting in-hospital mortality in COVID-19 patients. Thus, the findings from this study suggest that the use of NEWS may be beneficial to the early identification of high-risk COVID-19 patients and the provision of more aggressive care to reduce mortality associated with COVID-19.

Predictive Value of SOFA and qSOFA for In-Hospital Mortality in COVID-19 Patients: A Single-Center Study in Romania

“…Other studies showing the accuracy of risk scores presented conflicting results, with AUCs between 0.679 and 0.908 [ 15 , 16 ]. In addition, consistent with our results, one study shows qSOFA to have less predictive value in COVID-19 mortality compared to other risk scores [ 5 , 17 ].…”

“…Compared to other risk scores, for example, 4C mortality, CURB-65, and NEWS (The National Early Warning Score), calculated among the same patients and presented in a previous paper, SOFA had a poorer predictive value, with an AUC = 0.800 compared with 0.818 (4C mortality score), 0.861 (NEWS), and 0.801 (CURB-65) [ 5 ]. These results are consistent with other studies showing lower accuracy of the SOFA than the 4C mortality score [ 16 ].…”

“…The criteria for inclusion of participants were described in a previous paper evaluating the predictive value of the 4C mortality score, CURB-65, and NEWS in COVID-19 mortality among patients admitted to the Timisoara Municipal Emergency Hospital [ 5 ]. Thus, participants included in the study had met the following criteria: (1) had been admitted to the Municipal Emergency Hospital following a positive test for SARS-CoV-2 by real-time reverse transcriptase chain reaction (RT-PCR) on a nasopharyngeal swab between 1 October 2020 and 15 March 2021; (2) had complete clinical and laboratory data documented in electronic medical records; (3) were over 18 years of age.…”

“…Meanwhile, in Romania, about 65 thousand deaths out of 2.8 million confirmed cases of COVID-19 have been reported [ 1 , 2 ]. Throughout this pandemic, different scores and inflammatory markers have been successfully used to predict the severity and mortality of COVID-19 patients [ 3 , 4 , 5 ]. Other scoring systems that are used in the prediction of disease severity and mortality are SOFA (Sequential Organ Failure Assessment) and qSOFA (Quick Sequential Organ Failure Assessment) [ 6 , 7 ].…”

Predictive Value of Blood Coagulation Parameters in Poor Outcomes in COVID-19 Patients: A Retrospective Observational Study in Romania

“…Therefore, in this retrospective study, we analyzed the clinical and laboratory data of 82 patients from Municipal Emergency Clinical Hospital of Timisoara, Romania with COVID-19 which were collected at the time of admission. Our study, based on coagulation dysfunction, analyzes the mortality rate of COVID-19 patients, which was 20.7%, higher than in other studies conducted in Romania at different periods on COVID-19 patients where the mortality rate was 13.5% and 15.7% respectively [ 12 , 13 ]. This higher rate can be explained by the fact that the other studies included patients admitted earlier during the pandemic, when protocols issued by the health authorities in Romania required the admission of all COVID-19 positive persons, including asymptomatic or mildly ill individuals.…”