Evaluation of Mortality in ICU-admitted COVID-19 Patients Using Four Scoring Models: REMS, APACHE-II, CCI, and SOFA
Mediterranean Journal of Infection, Microbes and Antimicrobials
The study analyzes the effectiveness of four scoring models in mortality prediction in intensive care unit (ICU)-admitted COVID-19 patients. The models were Rapid Emergency Medicine Score (REMS), Charlson Comorbidity Index (CCI), Acute Physiology and Chronic Health Evaluation II (APACHE-II), and the Sequential Organ Failure Assessment (SOFA). Materials and Methods: A single-center and retrospective analysis was carried out with confirmed and suspect COVID-19 patients who were admitted to the ED
... between March 3, 2020, and December 31, 2020, and directly transferred to the ICU after being diagnosed with COVID-19. Four scoring models, namely, REMS, APACHE-II, CCI, and SOFA, were used to evaluate the factors affecting mortality in the patients. Results: The sample included 411 patients who were above 18 years of age, had a median age of 71 (IQR: 60-80) and included 61.6% male patients. A bad prognosis was associated with high creatinine levels, potassium (K) levels, FiO levels, and white blood cell levels and linked to low hematocrit (HTC) levels, pH, mean arterial pressure, and systolic and diastolic blood pressure. The results indicated statistically significant differences in the said laboratory values and physiological findings (p<0.05). Moreover, comorbidities were observed in 368 (89.5%) patients, and malignancy and dementia were significantly associated with death (p<0.001 and 0.019, respectively). All scoring systems (REMS, CCI, APACHE-II, and SOFA) were significant indicators of in-hospital mortality (p<0.001). However, the ROC analysis revealed no significant differences in the scoring systems in terms of their discriminatory power (p>0.05). Conclusion: The results showed that the REMS, CCI, APACHE-II, and SOFA were effective in the prediction of in-hospital mortality of critically ill COVID-19 patients; however, no scoring system prevailed over others. Therefore, the REMS, APACHE-II, CCI, and SOFA scoring models can guide not only emergency physicians but also all clinicians who contribute to the management of critical COVID-19 cases.