Modified COVID-19 Mortality Scoring as a Mortality Prognostic in COVID-19 Patients

https://doi.org/10.22146/ahj.v4i1.72845

Rahmadani Puji Lestari(1*), Benedictus Hangga Harinawantara(2), Khoironi Rachmad Damarjati(3), Purwadi Sujalmo(4)

(1) UGM Academic Hospital
(2) UGM Academic Hospital
(3) UGM Academic Hospital
(4) UGM Academic Hospital
(*) Corresponding Author

Abstract


Background: The number of patients infected with COVID-19 was increasing. The COVID-19 clinical presentation varies from asymptomatic, mild, moderate, severe, and critical. Mortality rates increase with morbidity and disease severity. This study aimed to develop a prognostic intrahospital mortality scoring named "Modified COVID-19 Mortality Scoring".

Methods: A retrospective cohort study was conducted on COVID-19 inpatients at the UGM Academic Hospital during November 2020-March 2021. Data were obtained from electronic medical records. Clinical and laboratory parameters were taken at the time of admission.

Results: The study involved 413 patients, including 50 subjects who died from COVID-19 and 363 survivors. The final stage of multivariate analysis resulted in some variables; age≥55 years, history of stroke, qSOFA score≥2, d-dimer≥1500 ng/mL, absolute neutrophil count (ANC)≥5,000 cells/uL, and absolute lymphocyte count (ALC)<1,000 cells /uL affected intrahospital mortality (p<0.050). In the scoring model, the d-dimer≥1500 ng/mL was worth 2 points, and each remaining variable was worth 1 point. The score had a strong predictive ability with an area under the ROC curve, 0.814(95%CI=0.757–0.871). The sensitivity and specificity of the score was 76%, with a cutoff point score of 3, an OR of 10,357 (95%CI=5.179-20,710, p=0.000). Moreover, the probability scores of 3, 4,5,6,7 were 18%, 33%, 53%, 72%, and 85%.

Conclusion: The existence of a scoring system is expected to help identify COVID-19 inpatients who have a higher risk of death so that stricter monitoring and early intervention can be carried out.


Keywords


COVID-19, Indonesia, intrahospital mortality scoring, prognostic.

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References

Ciotti M, Ciccozzi M, Terrinoni A, Jiang WC, Wang C Bin, Bernardini S. The COVID-19 pandemic. Crit Rev Clin Lab Sci [Internet]. 2020;0(0):365–88. Available from: https://doi.org/10.1080/10408363.2020.1783198

Fraser N, Brierley L, Dey G, Polka JK, Pálfy M, Nanni F, et al. The evolving role of preprints in the dissemination of COVID-19 research and their impact on the science communication landscape. PLoS Biol [Internet]. 2021;19(4):1–28. Available from: doi:10.1371/JOURNAL.PBIO.3000959

Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol [Internet]. 2020;215(April). Available from: https://doi.org/10.1016/j.clim.2020.108427

Wolff D, Nee S, Hickey NS, Marschollek M. Risk factors for Covid-19 severity and fatality: a structured literature review. Infection [Internet]. 2021;49(1):15–28. Available from: https://doi.org/10.1007/s15010-020-01509-1

Omer SB, Malani P, Rio C del. The COVID-19 Pandemic in the US A Clinical Update. JAMA [Internet]. 2020;323(18):1767–8. Available from: doi:10.1001/jama.2020.5788

Choudhary S, Sreenivasulu K, Mitra P, Misra S, Sharma P. Role of genetic variants and gene expression in the susceptibility and severity of COVID-19. Ann Lab Med [Internet]. 2020;41(2):129–38. Available from: https://doi.org/10.3343/alm.2021.41.2.129

Dyer O. Covid-19: Indonesia becomes Asia’s new pandemic epicentre as delta variant spreads. BMJ [Internet]. 2021;374(July):n1815. Available from: http://dx.doi.org/10.1136/bmj.n1815

Silva SJR da, Pena L. Collapse of the public health system and the emergence of new variants during the second wave of the COVID-19 pandemic in Brazil. One Heal [Internet]. 2021;13(June):100287. Available from: https://doi.org/10.1016/j.onehlt.2021.100287

Tareq AM, Emran T Bin, Dhama K, Dhawan M, Tallei TE. Impact of SARS-CoV-2 delta variant (B.1.617.2) in surging second wave of COVID-19 and efficacy of vaccines in tackling the ongoing pandemic. Hum Vaccines Immunother [Internet]. 2021;00(00):1–2. Available from: https://doi.org/10.1080/21645515.2021.1963601

Supady A, Brodie D, Curtis JR. Ten things to consider when implementing rationing guidelines during a pandemic. Intensive Care Med [Internet]. 2021;47(5):605–8. Available from: https://doi.org/10.1007/s00134-021-06374-6

Haimovich AD, Ravindra NG, Stoytchev S, Young HP, Wilson FP, van Dijk D, et al. Development and Validation of the Quick COVID-19 Severity Index: A Prognostic Tool for Early Clinical Decompensation. Ann Emerg Med [Internet]. 2020;76(4):442–53. Available from: https://doi.org/10.1016/j.annemergmed.2020.07.022

Piva S, Filippini M, Turla F, Cattaneo S, Margola A, De Fulviis S, et al. Clinical presentation and initial management critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Brescia, Italy. J Crit Care [Internet]. 2020;58:29–33. Available from: https://doi.org/10.1016/j.jcrc.2020.04.004

Rodriguez-Nava G, Yanez-Bello MA, Trelles-Garcia DP, Chung CW, Friedman HJ, Hines DW. Performance of the quick COVID-19 severity index and the Brescia-COVID respiratory severity scale in hospitalized patients with COVID-19 in a community hospital setting. Int J Infect Dis [Internet]. 2021;102:571–6. Available from: https://doi.org/10.1016/j.ijid.2020.11.003

Bels JLM, van Kuijk SMJ, Ghossein-Doha C, Tijssen FH, van Gassel RJJ, Tas J, et al. Decreased serial scores of severe organ failure assessments are associated with survival in mechanically ventilated patients; the prospective Maastricht Intensive Care COVID cohort. J Crit Care [Internet]. 2021;62:38–45. Available from: https://doi.org/10.1016/j.jcrc.2020.11.006

Gue YX, Tennyson M, Gao J, Ren S, Kanji R, Gorog DA. Development of a novel risk score to predict mortality in patients admitted to hospital with COVID ‑ 19. Sci Rep [Internet]. 2020;(0123456789):1–8. Available from: https://doi.org/10.1038/s41598-020-78505-w

Sensusiati AD, Amin M, Nasronudin N, Rosyid AN, Ramadhan NA, Lathifah R, et al. Age, neutrophil lymphocyte ratio, and radiographic assessment of the quantity of lung edema (RALE) score to predict in-hospital mortality in COVID-19 patients: A retrospective study. F1000Research [Internet]. 2021;9:1–13. Available from: https://doi.org/10.12688/f1000research.26723.2

Surendra H, Elyazar IR, Djaafara BA, Ekawati LL, Saraswati K, Adrian V, et al. Clinical characteristics and mortality associated with COVID-19 in Jakarta, Indonesia: A hospital-based retrospective cohort study. Lancet Reg Heal - West Pacific [Internet]. 2021;9:100108. Available from: https://doi.org/10.1016/j.lanwpc.2021.100108

Liu S, Yao N, Qiu Y, He C. Predictive performance of SOFA and qSOFA for in-hospital mortality in severe novel coronavirus disease. Am J Emerg Med [Internet]. 2020;38:2074–80. Available from: https://doi.org/10.1016/j.ajem.2020.07.019

Henry BM, Cheruiyot I, Vikse J, Mutua V, Kipkorir V, Benoit J, et al. Lymphopenia and neutrophilia at admission predicts severity and mortality in patients with COVID-19: A meta-analysis. Acta Biomed [Internet]. 2020;91(3):1–16. Available from: doi.org/10.23750/abm.v91i3.10217

Poudel A, Poudel Y, Adhikari A, Aryal BB, Dangol D, Bajracharya T, et al. D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19. PLoS One [Internet]. 2021;16(8 August 2021):1–13. Available from: http://dx.doi.org/10.1371/journal.pone.0256744

King JT, Yoon JS, Rentsch CT, Tate JP, Park LS, Kidwai-Khan F, et al. Development and validation of a 30-day mortality index based on pre-existing medical administrative data from 13,323 COVID-19 patients: The Veterans Health Administration COVID-19 (VACO) Index. PLoS One [Internet]. 2020;15(11 November):1–16. Available from: http://dx.doi.org/10.1371/journal.pone.0241825

Knight SR, Ho A, Pius R, Buchan I, Carson G, Drake TM, et al. Risk stratification of patients admitted to hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: Development and validation of the 4C Mortality Score. BMJ [Internet]. 2020;370(September):1–13. Available from: http://dx.doi.org/10.1136/bmj.m3339

The World Bank. Life expectancy at birth, total (years) - Indonesia [Internet]. [cited 2021 Oct 16]. Available from: https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=ID

Weng Z, Chen Q, Li S, Li H, Zhang Q, Lu S, et al. ANDC: An early warning score to predict mortality risk for patients with Coronavirus Disease 2019. J Transl Med [Internet]. 2020;18(1):1–10. Available from: https://doi.org/10.1186/s12967-020-02505-7



DOI: https://doi.org/10.22146/ahj.v4i1.72845

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