Abstract
BackgroundSeveral specific risk scores for Coronavirus disease 2019 (COVID-19) involving clinical and biochemical parameters have been developed from higher-risk patients, in addition to validating well-established pneumonia risk scores. We compared multiple risk scores in predicting more severe disease in a cohort of young patients with few comorbid illnesses. Accurately predicting the progression of COVID-19 may guide triage and therapy.MethodsWe retrospectively examined 554 hospitalised COVID-19 patients in Singapore. The CURB-65 score, Pneumonia Severity Index (PSI), ISARIC 4C prognostic score (4C), CHA2DS2-VASc score, COVID-GRAM Critical Illness risk score (COVID-GRAM), Veterans Health Administration COVID-19 index for COVID-19 Mortality (VACO), and the “rule-of-6” score were compared for three performance characteristics: the need for supplemental oxygen, intensive care admission and mechanical ventilation.ResultsA majority of patients were young (≤ 40 years, n = 372, 67.1%). 57 (10.3%) developed pneumonia, with 16 (2.9% of study population) requiring supplemental oxygen. 19 patients (3.4%) required intensive care and 2 patients (0.5%) died. The clinical risk scores predicted patients who required supplemental oxygenation and intensive care well. Adding the presence of fever to the CHA2DS2-VASc score and 4C score improved the ability to predict patients who required supplemental oxygen (c-statistic 0.81, 95% CI 0.68–0.94; and 0.84, 95% CI 0.75–0.94 respectively).ConclusionSimple scores including well established pneumonia risk scores can help predict progression of COVID-19. Adding the presence of fever as a parameter to the CHA2DS2-VASc or the 4C score improved the performance of these scores in a young population with few comorbidities.
Highlights
Several specific risk scores for Coronavirus disease 2019 (COVID-19) involving clinical and biochemical parameters have been developed from higher-risk patients, in addition to validating well-established pneumonia risk scores
We examined the first 554 confirmed consecutive patients with reverse transcriptase-polymerase chain reaction (RT-PCR) proven COVID-19 admitted to a single tertiary institution in Singapore from 23rd January 2020 to 30th April 2020
This includes the COVIDGRAM score, developed and validated in large Chinese cohorts of patients [13], the ISARIC 4C prognostic score (4C) score was derived and validated by cohorts in the United Kingdom [10], the VACO score [12], validated in multiple large American cohorts [22], and the Rule-of -6 score developed from a small cohort in Singapore [11]
Summary
Several specific risk scores for Coronavirus disease 2019 (COVID-19) involving clinical and biochemical parameters have been developed from higher-risk patients, in addition to validating well-established pneumonia risk scores. Despite the shocking amount of death and morbidity from this disease, it is estimated up to 80% of patients have mild disease or are asymptomatic, with 14% having severe disease including pneumonia and the remaining 5% with critical illness including multi-organ failure (MOF), septic shock, respiratory failure which can progress to death [2]. Risk scores developed and utilised far have focused on predicting which patients who develop severe to critical disease and would benefit from intensive care therapies [4,5,6] It may, be more useful to discover a risk score which can predict those who progress to needing the earlier stage of oxygenation, when the initiation of COVID19 specific therapies have more utility. Far the COVID-19 specific risk scores developed require several laboratory parameters or complicated clinical parameter calculations [10,11,12,13], yet a simple tool that did not require laboratory parameters would be of greater utility in an emergency room or clinic setting, especially in low and middle income countries
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