Abstract
BackgroundAs the COVID-19 pandemic continues, the number of patients admitted to the intensive care unit (ICU) is still increasing. The aim of our article is to estimate which of the conventional ICU mortality risk scores is the most accurate at predicting mortality in COVID-19 patients and to determine how these scores can be used in combination with the 4C Mortality Score.MethodsThis was a retrospective study of critically ill COVID-19 patients treated in tertiary reference COVID-19 hospitals during the year 2020. The 4C Mortality Score was calculated upon admission to the hospital. The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores were calculated upon admission to the ICU. Patients were divided into two groups: ICU survivors and ICU non-survivors.ResultsA total of 249 patients were included in the study, of which 63.1% were male. The average age of all patients was 61.32 ± 13.3 years. The all-cause ICU mortality ratio was 41.4% (n = 103). To determine the accuracy of the ICU mortality risk scores a ROC-AUC analysis was performed. The most accurate scale was the APACHE II, with an AUC value of 0.772 (95% CI 0.714–0.830; p < 0.001). All of the ICU risk scores and 4C Mortality Score were significant mortality predictors in the univariate regression analysis. The multivariate regression analysis was completed to elucidate which of the scores can be used in combination with the independent predictive value. In the final model, the APACHE II and 4C Mortality Score prevailed. For each point increase in the APACHE II, mortality risk increased by 1.155 (OR 1.155, 95% CI 1.085–1.229; p < 0.001), and for each point increase in the 4C Mortality Score, mortality risk increased by 1.191 (OR 1.191, 95% CI 1.086–1.306; p < 0.001), demonstrating the best overall calibration of the model.ConclusionsThe study demonstrated that the APACHE II had the best discrimination of mortality in ICU patients. Both the APACHE II and 4C Mortality Score independently predict mortality risk and can be used concomitantly.
Highlights
As the COVID-19 pandemic continues, the number of patients admitted to the intensive care unit (ICU) is still increasing
As the SARS-CoV-2 (COVID-19) pandemic has continued in the year 2020, the number of COVID-19 patients admitted to the intensive care unit (ICU) around the world has severely increased
The most accurate scale was the Acute Physiology and Chronic Health Evaluation (APACHE) Acute Physiology and Chronic Health Evaluation II (II), with an AUC value of 0.772
Summary
As the COVID-19 pandemic continues, the number of patients admitted to the intensive care unit (ICU) is still increasing. The SOFA score uses clinical parameters and laboratory values, while the SAPS II and APACHE II include age, history of severe organ failure or chronic disease and type of admission. The APACHE II and SAPS II should be calculated on newly admitted patients, while the SOFA score can be recalculated every 24 h [8] All of these scales have perfect calibration and discrimination across all ranges of possible values, determining the risk of mortality from 1% to almost up to 100%. It is important to note that the APACHE II was originally developed to fit all kinds of ICU populations It might not be as precise when evaluating specific patient groups and individual patients. None of these scores are perfect in every setting, and none of them is specific to one illness, being less accurate in patients which have a particular disease
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