Deterioration Scores in Covid-19 Delta Variant

ABSTRACT

Rationale The early recognition of COVID-19 patients at high risk of clinical deterioration is important to help triage, allocate resources, and improve patient care. In this study, we aimed to compare the performance of the Charlson Comorbidity Index (CCI), mSOFA, MEWS, qCSI, and PRIEST COVID-19 Clinical Severity scores in predicting risk of admission to the intensive care unit (ICU) and in-hospital mortality. Methods: This was a multicenter retrospective cohort study which included a random sample of confirmed COVID-19 patients admitted to three academic medical centers. All patients were admitted in July 2021. Patients with a positive COVID-19 polymerase chain reaction at time of admission were included. All scores were calculated within the first 24 hours of admission to the hospital. A univariate and backward multivariate logistic regression analysis were used to evaluate correlation of CCI, mSOFA, MEWS, qCSI, and PRIEST COVID-19 Clinical Severity score to the primary outcome, ICU admission, and secondary outcome, death (in-hospital). Results: One-hundred and three patients were included in this study with a median age of 59 years old (IQR 51-70). The majority were male (64.1%, n = 66) and Caucasian (81.6%, n = 84). Twenty-six patients (25.2%) required ICU admission with an in-hospital death occurring in nine patients (8.7%). In the multivariate analysis, patients admitted to the ICU were more likely to be African-American (12.96 OR;95% CI 1.49, 155.91), and of the five scores assessed, mSOFA (1.61 OR;95% CI 1.13, 2.41), MEWS (1.74 OR;95% CI 1.06, 3.09), and qCSI (1.52 OR;95% CI 1.12, 2.16) scores were associated with ICU admission. However, only mSOFA score (1.93 OR;95% CI 1.34, 3.11) was associated with in-hospital mortality. Conclusions: There are multiple scores for COVID-19 clinical deterioration that are accurate in predicting the need for ICU admission. Despite the ability to predict clinical deterioration, other scores were not associated with an increased in-hospital mortality. Interestingly, the CCI was not associated with an increased in-hospital mortality. This study provides evidence to use the mSOFA, along with other scores to accurately triage patients to a higher level of care.