Abstract
In this study, we compare the predictive value of clinical scoring systems that are already in use in patients with Coronavirus disease 2019 (COVID-19), including the Brescia-COVID Respiratory Severity Scale (BCRSS), Quick SOFA (qSOFA), Sequential Organ Failure Assessment (SOFA), Multilobular infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension, and Age (MuLBSTA) and scoring system for reactive hemophagocytic syndrome (HScore), for determining the severity of the disease. Our aim in this study is to determine which scoring system is most useful in determining disease severity and to guide clinicians. We classified the patients into two groups according to the stage of the disease (severe and non-severe) and adopted interim guidance of the World Health Organization. Severe cases were divided into a group of surviving patients and a deceased group according to the prognosis. According to admission values, the BCRSS, qSOFA, SOFA, MuLBSTA, and HScore were evaluated at admission using the worst parameters available in the first 24 h. Of the 417 patients included in our study, 46 (11%) were in the severe group, while 371 (89%) were in the non-severe group. Of these 417 patients, 230 (55.2%) were men. The median (IQR) age of all patients was 44 (25) years. In multivariate logistic regression analyses, BRCSS in the highest tertile (HR 6.1, 95% CI 2.105–17.674, p = 0.001) was determined as an independent predictor of severe disease in cases of COVID-19. In multivariate analyses, qSOFA was also found to be an independent predictor of severe COVID-19 (HR 4.757, 95% CI 1.438–15.730, p = 0.011). The area under the curve (AUC) of the BRCSS, qSOFA, SOFA, MuLBSTA, and HScore was 0.977, 0.961, 0.958, 0.860, and 0.698, respectively. Calculation of the BRCSS and qSOFA at the time of hospital admission can predict critical clinical outcomes in patients with COVID-19, and their predictive value is superior to that of HScore, MuLBSTA, and SOFA. Our prediction is that early interventions for high-risk patients, with early identification of high-risk group using BRCSS and qSOFA, may improve clinical outcomes in COVID-19.
Highlights
COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pandemic infectious disease that causes morbidity and mortality
For patients who have higher Sequential Organ Failure Assessment (SOFA) scores and lymphocytopenia on admission, there is a greater risk of developing severe COVID-19 d isease2
Fardet et al developed the HScore to help clinicians in the differential diagnosis of reactive hemophagocytic syndrome (RHS)10, which is usually known as macrophage activation syndrome (MAS) when it is secondary to a rheumatic disease11
Summary
COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pandemic infectious disease that causes morbidity and mortality. The fact that many clinical, hematological, and biochemical parameters change during the inflammation process of COVID-19 suggests that it is possible to form an idea about the prognosis of the disease with scoring systems. We can assume that risk of death is increased by 2 to 25 times compared to patients with a SOFA score of less than 2 1,3. For patients who have higher SOFA scores and lymphocytopenia on admission, there is a greater risk of developing severe COVID-19 d isease. The quickSOFA (qSOFA) system has been developed as a bedside clinical scoring system to classify patients clinically according to the severity of sepsis. Some authors have said that it may not be appropriate to use the HScore to guide the use of immunomodulatory t herapy
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