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Early Warning Scores at Time of ICU Admission to Predict Mortality in Critically Ill COVID-19 Patients.
Tyagi, Asha; Tyagi, Surbhi; Agrawal, Ananya; Mohan, Aparna; Garg, Devansh; Salhotra, Rashmi; Saxena, Ashok Kumar; Goel, Ashish.
  • Tyagi A; Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi, India.
  • Tyagi S; Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi, India.
  • Agrawal A; Hamdard Institute of Medical Sciences & Research, New Delhi, India.
  • Mohan A; Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi, India.
  • Garg D; Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi, India.
  • Salhotra R; Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi, India.
  • Saxena AK; Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi, India.
  • Goel A; Department of Medicine, University College of Medical Sciences & GTB Hospital, Delhi, India.
Disaster Med Public Health Prep ; : 1-5, 2021 Jun 18.
Article in English | MEDLINE | ID: covidwho-2250352
ABSTRACT

OBJECTIVE:

To assess ability of National Early Warning Score 2 (NEWS2), systemic inflammatory response syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), and CRB-65 calculated at the time of intensive care unit (ICU) admission for predicting ICU mortality in patients of laboratory confirmed coronavirus disease 2019 (COVID-19) infection.

METHODS:

This prospective data analysis was based on chart reviews for laboratory confirmed COVID-19 patients admitted to ICUs over a 1-mo period. The NEWS2, CRB-65, qSOFA, and SIRS were calculated from the first recorded vital signs upon admission to ICU and assessed for predicting mortality.

RESULTS:

Total of 140 patients aged between 18 and 95 y were included in the analysis of whom majority were >60 y (47.8%), with evidence of pre-existing comorbidities (67.1%). The most common symptom at presentation was dyspnea (86.4%). Based upon the receiver operating characteristics area under the curve (AUC), the best discriminatory power to predict ICU mortality was for the CRB-65 (AUC 0.720 [95% confidence interval [CI] 0.630-0.811]) followed closely by NEWS2 (AUC 0.712 [95% CI 0.622-0.803]). Additionally, a multivariate Cox regression model showed Glasgow Coma Scale score at time of admission (P < 0.001; adjusted hazard ratio = 0.808 [95% CI 0.715-0.911]) to be the only significant predictor of ICU mortality.

CONCLUSIONS:

CRB-65 and NEWS2 scores assessed at the time of ICU admission offer only a fair discriminatory value for predicting mortality. Further evaluation after adding laboratory markers such as C-reactive protein and D-dimer may yield a more useful prediction model. Much of the earlier data is from developed countries and uses scoring at time of hospital admission. This study was from a developing country, with the scores assessed at time of ICU admission, rather than the emergency department as with existing data from developed countries, for patients with moderate/severe COVID-19 disease. Because the scores showed some utility for predicting ICU mortality even when measured at time of ICU admission, their use in allocation of limited ICU resources in a developing country merits further research.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study Language: English Journal: Disaster Med Public Health Prep Journal subject: Public Health Year: 2021 Document Type: Article Affiliation country: Dmp.2021.208

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study Language: English Journal: Disaster Med Public Health Prep Journal subject: Public Health Year: 2021 Document Type: Article Affiliation country: Dmp.2021.208