Prognostic Performance of Sofa Score in Conjunction with Inflammatory Markers in Critically-Ill COVID-19 Patients ABS0193)

ABSTRACT

Aim and background: COVID-19 pandemic is still posing a great challenge to the global healthcare system. Accumulating evidence from various studies suggests that the serum levels of inflammatory markers have the potential in determining the severity of disease, and possibly may serve as potential prognostic biomarkers for COVID-19. Increased levels of inflammatory markers such as interleukin-6 (IL-6), procalcitonin (PCT), d-dimer, C-reactive protein (CRP), and ferritin, are found to be associated with poor clinical outcomes in severe patients. Application of scoring system for critically-ill COVID-19 patients facilitates intensivists for prognosis and predicting mortality. However, no such scoring system is yet available for COVID-19. Therefore, the existing scoring systems, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, and Sequential Organ Failure Assessment (SOFA) score are used to assess disease severity and estimate mortality in critically ill COVID- 19 patients. Objective: To determine the potential of ICU-based scoring system Sequential Organ Failure Assessment (SOFA) score in combination with inflammatory markers as predictors of 28 days mortality in critically-ill COVID-19 patients. Materials and methods: This is a single-center, observational cohort study, conducted in Max Superspeciality Hospital, Vaishali, Ghaziabad, U.P. (India). The study included 80 critically ill COVID-19 patients admitted to ICU from 3rd August to 2nd October 2020. The patients were followed up for 28 days or until their death. The core outcome was 28 days mortality in COVID-19 patients admitted to ICU. SOFA score was calculated from the time of admission (0 hours) up till 96 hours of ICU stay, to predict the severity of the disease. The levels of inflammatory markers (serum levels of IL-6, d-dimer, procalcitonin, C-reactive protein, and ferritin) were measured at the time of admission (0 hours) and 96 hours after admission. The statistical analysis was performed using IBM Statistical Product and Service Solutions (SPSS) version 17.0. Results: Among the 80 patients admitted to the ICU, 56 survived while 24 patients died at the hospital. Comorbidities were present in 60 patients, with diabetes being the most common, followed by hypertension. At 96 hours of admission to ICU, the SOFA score was significantly higher in non-survivors than survivors (3.75 ± 2.94 vs 2.16 ± 0.87;P < 0.001). Multivariable regression analysis showed significantly increased odds of mortality associated with higher SOFA score (OR- 2.228 [95% CI 1.220-4.068];P = 0.009) and Procalcitonin levels (OR- 1.983 [95% CI 1.129-3.485];P = 0.017) at 96 hours of admission. The ROC analysis showed SOFA score ≥4 and PCT ≥0.6 as cut-off values. Conclusion: The present study indicates that using SOFA score along with procalcitonin could function as an effective prognostic tool to predict 28-day mortality in critically-ill COVID-19 patients. However, increased PCT levels could be due to bacterial co-infections, hence additional studies are required to assess the validity of PCT in critically ill COVID-19 pts.