QSOFA score poorly predicts critical progression in COVID-19 patients

Sven Heldt,Guangyu Shao,Bernhard Kaiser,Bernd Lamprecht,Helmut J F Salzer,Markus Winkler,Thomas Tschoellitsch,Christian Paar,Jens Meier,Martin Duenser,Nora Kainzbauer,Matthias Neuböck

doi:10.1007/s10354-021-00856-4

Sven Heldt, Guangyu Shao + Show 10 more

Open Access

https://doi.org/10.1007/s10354-021-00856-4

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Abstract

BackgroundIn December 2019, the new virus infection coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged. Simple clinical risk scores may improve the management of COVID-19 patients. Therefore, the aim of this pilot study was to evaluate the quick Sequential Organ Failure Assessment (qSOFA) score, which is well established for other diseases, as an early risk assessment tool predicting a severe course of COVID-19.MethodsWe retrospectively analyzed data from adult COVID-19 patients hospitalized between March and July 2020. A critical disease progress was defined as admission to intensive care unit (ICU) or death.ResultsOf 64 COVID-19 patients, 33% (21/64) had a critical disease progression from which 13 patients had to be transferred to ICU. The COVID-19-associated mortality rate was 20%, increasing to 39% after ICU admission. All patients without a critical progress had a qSOFA score ≤ 1 at admission. Patients with a critical progress had in only 14% (3/21) and in 20% (3/15) of cases a qSOFA score ≥ 2 at admission (p = 0.023) or when measured directly before critical progression, respectively, while 95% (20/21) of patients with critical progress had an impairment oxygen saturation (SO2) at admission time requiring oxygen supplementation.ConclusionA low qSOFA score cannot be used to assume short-term stable or noncritical disease status in COVID-19.

Highlights

At the end of December 2019, several cases of an ominous acute respiratory disease were reported from Wuhan city in China
Paar Institute of Laboratory Medicine, Kepler University Hospital, Linz, Austria and in 20% (3/15) of cases a quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2 at admission (p = 0.023) or when measured directly before critical progression, respectively, while 95% (20/21) of patients with critical progress had an impairment oxygen saturation (SO2) at admission time requiring oxygen supplementation
We included adult patients who were admitted to the hospital not requiring intensive care unit (ICU) initially (= normal ward) and had a positive SARS-CoV-2 realtime polymerase chain reaction (PCR) test

Summary

Introduction

At the end of December 2019, several cases of an ominous acute respiratory disease were reported from Wuhan city in China. A new strain of a contagious coronavirus was identified called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19). On March 11, 2020, the World Health Organization (WHO) officially declared the emerging spread of SARS-CoV-2 as a pandemic. Risk scores predicting severe courses of COVID19 could be useful leading to early and more intense monitoring. This would be important to initiate necessary intensive medical measures at an early stage, to look closer on other effected organ systems than the respiratory system (especially for affected renal function, neurologic impairments, and myocardial involvement [1]) and to initiate the necessary instrumental diagnostics, which would otherwise be used rather cautiously due to the risk of infection

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