External Validation of Mortality Scores among High-Risk COVID-19 Patients: A Romanian Retrospective Study in the First Pandemic Year

Abstract

Background: We aimed to externally validate three prognostic scores for COVID-19: the 4C Mortality Score (4CM Score), the COVID-GRAM Critical Illness Risk Score (COVID-GRAM), and COVIDAnalytics. Methods: We evaluated the scores in a retrospective study on adult patients hospitalized with severe/critical COVID-19 (1 March 2020–1 March 2021), in the Teaching Hospital of Infectious Diseases, Cluj-Napoca, Romania. We assessed all the deceased patients matched with two survivors by age, gender, and at least two comorbidities. The areas under the receiver-operating characteristic curves (AUROCs) were computed for in-hospital mortality. Results: Among 780 severe/critical COVID-19 patients, 178 (22.8%) died. We included 474 patients according to the case definition (158 deceased/316 survivors). The median age was 75 years; diabetes mellitus, malignancies, chronic pulmonary diseases, and chronic kidney and moderate/severe liver diseases were associated with higher risks of death. According to the predefined 4CM Score, the mortality rates were 0% (low), 13% (intermediate), 27% (high), and 61% (very high). The AUROC for the 4CM Score was 0.72 (95% CI: 0.67–0.77) for in-hospital mortality, close to COVID-GRAM, with slightly greater discriminatory ability for COVIDAnalytics: 0.76 (95% CI: 0.71–0.80). Conclusion: All the prognostic scores showed close values compared to their validation cohorts, were fairly accurate in predicting mortality, and can be used to prioritize care and resources.

COVID-19 and Laboratory Markers from Romanian Patients—A Narrative Review

“…Its half-life is approximately 19 h and its concentration diminishes as the patient heals and the inflammatory stages pass [ 18 , 19 ]. This particular protein was studied extensively during the COVID-19 pandemic, as it is one of the earliest markers to show elevation since the beginning [ 14 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ].…”

“…An increase in LDH activity was seen in many cases of severe COVID-19, which may be related to cell destruction as well as poor blood flow and oxygen delivery. Elevated LDH levels were observed in many studies of Romanian patients [ 21 , 26 , 33 , 34 , 79 ], with one study focusing on how these values could be related to thrombotic microangiopathy by presenting a case report of a patient with a complement gene variant (complement factor I) [ 80 ] and another focusing on a pediatric case, signaling the risk for a systemic inflammatory syndrome associated with COVID-19 in some children [ 23 ]. Neonatal vertical infection is rare; however, in those cases, LDH was elevated [ 64 ].…”

“…The study by Davidescu et al observed a statistically significant difference between elders and non-elders in regard to AST [ 62 ]. Other cases were reported with elevated levels as well, with a tendency towards elevated AST rather than a modified ALT [ 23 , 24 , 25 , 26 , 30 , 34 , 35 , 36 , 37 , 59 , 64 , 79 , 97 ].…”

“…Elevated BUN levels may indicate impaired kidney function, which is a common complication of severe COVID-19 disease. Many authors have reported high levels in data from Romania and suggested a link with the severity of the infection, as well as a possible marker for severity [26,[32][33][34]40,62]. Some authors have reported other common renal markers such as creatinine and urea [30,40,59].…”

Effects of COVID-19 on the Liver and Mortality in Patients with SARS-CoV-2 Pneumonia Caused by Delta and Non-Delta Variants: An Analysis in a Single Centre

“…COVID-19 death predictors have been extensively evaluated in large databases all over the world, with age being the most important factor along with male sex, number of preexisting diseases, and many comorbidities like cardiovascular and/or cerebrovascular, obesity, diabetes, and dementia [ 11 , 38 , 39 , 40 , 41 , 42 ]. Fortunately, even in immunocompromised patients, SARS-CoV-2 infection severity was much lower in the Omicron wave compared with the previous waves, as demonstrated by the WHO ISARIC UK prospective cohort study [ 43 ].…”