Validating the RISE UP score for predicting prognosis in patients with COVID-19 in the emergency department: a retrospective study

Abstract

ObjectiveTo mitigate the burden of COVID-19 on the healthcare system, information on the prognosis of the disease is needed. The recently developed Risk Stratification in the Emergency Department in Acutely ill Older Patients (RISE UP) score has very good discriminatory value for short-term mortality in older patients in the emergency department (ED). It consists of six readily available items. We hypothesised that the RISE UP score could have discriminatory value for 30-day mortality in ED patients with COVID-19.DesignRetrospective analysis.SettingTwo EDs of the Zuyderland Medical Centre, secondary care hospital in the Netherlands.ParticipantsThe study sample consisted of 642 adult ED patients diagnosed with COVID-19 between 3 March and until 25 May 2020. Inclusion criteria were (1) admission to the hospital with symptoms suggestive of COVID-19 and (2) positive result of the PCR or (very) high suspicion of COVID-19 according to the chest CT scan.OutcomePrimary outcome was 30-day mortality, secondary outcome was a composite of 30-day mortality and admission to intensive care unit (ICU).ResultsWithin 30 days after presentation, 167 patients (26.0%) died and 102 patients (15.9%) were admitted to ICU. The RISE UP score showed good discriminatory value for 30-day mortality (area under the receiver operating characteristic curve (AUC) 0.77, 95% CI 0.73 to 0.81) and for the composite outcome (AUC 0.72, 95% CI 0.68 to 0.76). Patients with RISE UP scores below 10% (n=121) had favourable outcome (zero deaths and six ICU admissions), while those with scores above 30% (n=221) were at high risk of adverse outcome (46.6% mortality and 19.0% ICU admissions).ConclusionThe RISE UP score is an accurate prognostic model for adverse outcome in ED patients with COVID-19. It can be used to identify patients at risk of short-term adverse outcome and may help guide decision-making and allocating healthcare resources.

RISK STRATIFICATION OF PATIENTS WITH COVID-19 DISEASE THROUGH THE USE OF CLINICAL SCORES IN AN EMERGENCY DEPARTMENT. A review of the literature

“…Also RISE UP score by van Dam et. al 19 and 4C mortality score by Knight et. al 20 had excellent results.…”

“…Sensitivity, specificity, positive (PPV) and negative predicting value (NPV), diagnostic accuracy, Receiver operating characteristic (ROC) curve and the Area Under the Curve (AUC) of each score was calculated. To evaluate the values of the area below the ROC curve we referred to the classification proposed by Swets 19 :…”

“…We excluded 301 articles that did not meet the search question and 36 articles that did not meet the inclusion criteria. At the end 8 articles were evaluated [13][14]16,[18][19][20][21]23 . Five were retrospective observational studies and three prospective.…”

The AIFELL Score as a Predictor of Coronavirus Disease 2019 (COVID-19) Severity and Progression in Hospitalized Patients

“…Other scores were developed for specific cohorts (e.g., geriatric patients [26]). Some nonspecific early warning scores have been used in COVID-19 patients in various settings [27][28][29].…”

Early Biochemical Analysis of COVID-19 Patients Helps Severity Prediction

“…Several works have tried to identify risk and prognostic factors based on demographic, epidemiologic, genetic, and clinical variables [2][3][4][5][6], and several models have been proposed for mortality and severity prediction, but they present diverse outcomes and no consensus has been reached yet on their application [7].…”