Practical Applicability of the ISARIC-4C Score on Severity and Mortality due to SARS-CoV-2 Infection in Patients with Type 2 Diabetes

Abstract

Background and objectives. There is a bidirectional relationship between SARS-CoV-2 infection and diabetes mellitus (DM), as people with DM are more vulnerable, and SARS-CoV-2 infections worsen the prognosis in these patients. The main purpose of the study was to evaluate the application validity of the ISARIC-4C score in patients confirmed with SARS-CoV-2 infection. Materials and Methods. The study included 159 patients previously known to have type 2 DM and confirmed positive for SARS-CoV-2 infection. We analyzed the concordance between the clinical evaluation of the patients and the ISARIC-4C score. Results. The mortality rate in hospitalized patients was 25.15%. The mortality risk was higher for ISARIC-4C values >14 than in the opposite group (63.93% vs. 31.24%; p < 0.001). The area under the curve (AUC) of the mortality score was 0.875 (95% CI: 0.820–0.930; p < 0.001), correctly classifying 77.36% of the cohort. A cut-off value of >14 had a sensitivity of 87.80% (95% CI: 87.66–87.93), specificity 73.72% (95% CI: 73.48–73.96), positive predictive value 53.73% (95% CI: 53.41–54.04), and negative predictive value 94.56% (95% CI: 94.5–94.62). The Cox regression model showed that the length of hospitalization (LH) was significantly influenced by body mass index, lung impairment, and aspartate aminotransferase, increasing the hazards, while lower HbA1c and lower SatO2 significantly decreased the hazards. Conclusions. ISARIC-4C score estimates the likelihood of clinical deterioration and the mortality risk in patients hospitalized with type 2 DM and positive for SARS-CoV-2, being useful in assessing the prognosis from the onset, as well as in developing therapeutic strategies.

Assessment of the Negative Factors for the Clinical Outcome in Patients with SARS-CoV-2 Infection and Type 2 Diabetes Mellitus

“…These changes induce a prothrombotic state that causes cellular and tissue damage, especially in critical patients with multiple comorbidities. [36][37][38] In our study, patients with CVD and hypertension had a severe outcome and higher mortality rate. Patients who died had greater than 50% lung damage and SatO2 less than 80%.…”

Performance of CURB-65 and ISARIC 4C mortality scores for hospitalized patients with confirmed COVID-19 infection in Saudi Arabia

“…In another study, statistical significance in mortality differences between ISARIC 4C score categories was observed during the first wave of the COVID-19 pandemic [ 32 ]. Albaie et al reported that the ISARIC 4C mortality score is useful to assess the prognosis of patients with type 2 diabetes mellitus presenting with COVID-19 with an AUC of 0.875 using a cutoff value of >14 [ 33 ]. Another study from Saudi Arabia found that the ISARIC 4C Mortality Score is an excellent tool to predict mortality in critically ill COVID-19 patients with an AUC of 0.81; the sensitivity was 70.5% and the specificity 73.97% with a cutoff value of >9 [ 22 ].…”

Impact of Surge Strain and Pandemic Progression on Prognostication by an Established COVID-19–Specific Severity Score

“…However, proponents supported its age-agnostic approach to short-term risk stratification. Although 4C has demonstrated adequate calibration in different racial/ethnic groups ( 6 ), patients with advanced age, and those with underlying comorbidities ( 25 – 27 ), it relies heavily on age as the single most heavily weighted component. Here, we examined discriminative function of the m4C score by subtracting the age component and found that score AUC was diminished, but still better than that of the SOFA score reported elsewhere ( 3 , 4 ).…”