Comparison of mortality risk evaluation tools efficacy in critically ill COVID-19 patients

Abstract Background As the COVID-19 pandemic continues, the number of patients admitted to the intensive care unit (ICU) is still increasing. The aim of our article is to estimate which of the conventional ICU mortality risk scores is the most accurate at predicting mortality in COVID-19 patients an...

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Autores principales:	Vaidas Vicka, Elija Januskeviciute, Sigute Miskinyte, Donata Ringaitiene, Mindaugas Serpytis, Andrius Klimasauskas, Ligita Jancoriene, Jurate Sipylaite
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	ICU Risk scores Mortality COVID-19 Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/e7250b183b0d4033a8693068e750f60a
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spelling	oai:doaj.org-article:e7250b183b0d4033a8693068e750f60a2021-11-28T12:41:41ZComparison of mortality risk evaluation tools efficacy in critically ill COVID-19 patients10.1186/s12879-021-06866-21471-2334https://doaj.org/article/e7250b183b0d4033a8693068e750f60a2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12879-021-06866-2https://doaj.org/toc/1471-2334Abstract Background As the COVID-19 pandemic continues, the number of patients admitted to the intensive care unit (ICU) is still increasing. The aim of our article is to estimate which of the conventional ICU mortality risk scores is the most accurate at predicting mortality in COVID-19 patients and to determine how these scores can be used in combination with the 4C Mortality Score. Methods This was a retrospective study of critically ill COVID-19 patients treated in tertiary reference COVID-19 hospitals during the year 2020. The 4C Mortality Score was calculated upon admission to the hospital. The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores were calculated upon admission to the ICU. Patients were divided into two groups: ICU survivors and ICU non-survivors. Results A total of 249 patients were included in the study, of which 63.1% were male. The average age of all patients was 61.32 ± 13.3 years. The all-cause ICU mortality ratio was 41.4% (n = 103). To determine the accuracy of the ICU mortality risk scores a ROC-AUC analysis was performed. The most accurate scale was the APACHE II, with an AUC value of 0.772 (95% CI 0.714–0.830; p < 0.001). All of the ICU risk scores and 4C Mortality Score were significant mortality predictors in the univariate regression analysis. The multivariate regression analysis was completed to elucidate which of the scores can be used in combination with the independent predictive value. In the final model, the APACHE II and 4C Mortality Score prevailed. For each point increase in the APACHE II, mortality risk increased by 1.155 (OR 1.155, 95% CI 1.085–1.229; p < 0.001), and for each point increase in the 4C Mortality Score, mortality risk increased by 1.191 (OR 1.191, 95% CI 1.086–1.306; p < 0.001), demonstrating the best overall calibration of the model. Conclusions The study demonstrated that the APACHE II had the best discrimination of mortality in ICU patients. Both the APACHE II and 4C Mortality Score independently predict mortality risk and can be used concomitantly.Vaidas VickaElija JanuskeviciuteSigute MiskinyteDonata RingaitieneMindaugas SerpytisAndrius KlimasauskasLigita JancorieneJurate SipylaiteBMCarticleICURisk scoresMortalityCOVID-19Infectious and parasitic diseasesRC109-216ENBMC Infectious Diseases, Vol 21, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ICU Risk scores Mortality COVID-19 Infectious and parasitic diseases RC109-216
spellingShingle	ICU Risk scores Mortality COVID-19 Infectious and parasitic diseases RC109-216 Vaidas Vicka Elija Januskeviciute Sigute Miskinyte Donata Ringaitiene Mindaugas Serpytis Andrius Klimasauskas Ligita Jancoriene Jurate Sipylaite Comparison of mortality risk evaluation tools efficacy in critically ill COVID-19 patients
description	Abstract Background As the COVID-19 pandemic continues, the number of patients admitted to the intensive care unit (ICU) is still increasing. The aim of our article is to estimate which of the conventional ICU mortality risk scores is the most accurate at predicting mortality in COVID-19 patients and to determine how these scores can be used in combination with the 4C Mortality Score. Methods This was a retrospective study of critically ill COVID-19 patients treated in tertiary reference COVID-19 hospitals during the year 2020. The 4C Mortality Score was calculated upon admission to the hospital. The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores were calculated upon admission to the ICU. Patients were divided into two groups: ICU survivors and ICU non-survivors. Results A total of 249 patients were included in the study, of which 63.1% were male. The average age of all patients was 61.32 ± 13.3 years. The all-cause ICU mortality ratio was 41.4% (n = 103). To determine the accuracy of the ICU mortality risk scores a ROC-AUC analysis was performed. The most accurate scale was the APACHE II, with an AUC value of 0.772 (95% CI 0.714–0.830; p < 0.001). All of the ICU risk scores and 4C Mortality Score were significant mortality predictors in the univariate regression analysis. The multivariate regression analysis was completed to elucidate which of the scores can be used in combination with the independent predictive value. In the final model, the APACHE II and 4C Mortality Score prevailed. For each point increase in the APACHE II, mortality risk increased by 1.155 (OR 1.155, 95% CI 1.085–1.229; p < 0.001), and for each point increase in the 4C Mortality Score, mortality risk increased by 1.191 (OR 1.191, 95% CI 1.086–1.306; p < 0.001), demonstrating the best overall calibration of the model. Conclusions The study demonstrated that the APACHE II had the best discrimination of mortality in ICU patients. Both the APACHE II and 4C Mortality Score independently predict mortality risk and can be used concomitantly.
format	article
author	Vaidas Vicka Elija Januskeviciute Sigute Miskinyte Donata Ringaitiene Mindaugas Serpytis Andrius Klimasauskas Ligita Jancoriene Jurate Sipylaite
author_facet	Vaidas Vicka Elija Januskeviciute Sigute Miskinyte Donata Ringaitiene Mindaugas Serpytis Andrius Klimasauskas Ligita Jancoriene Jurate Sipylaite
author_sort	Vaidas Vicka
title	Comparison of mortality risk evaluation tools efficacy in critically ill COVID-19 patients
title_short	Comparison of mortality risk evaluation tools efficacy in critically ill COVID-19 patients
title_full	Comparison of mortality risk evaluation tools efficacy in critically ill COVID-19 patients
title_fullStr	Comparison of mortality risk evaluation tools efficacy in critically ill COVID-19 patients
title_full_unstemmed	Comparison of mortality risk evaluation tools efficacy in critically ill COVID-19 patients
title_sort	comparison of mortality risk evaluation tools efficacy in critically ill covid-19 patients
publisher	BMC
publishDate	2021
url	https://doaj.org/article/e7250b183b0d4033a8693068e750f60a
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Comparison of mortality risk evaluation tools efficacy in critically ill COVID-19 patients

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