tetano
Editor, Senior Moderator
J Clin Med
. 2022 Jul 18;11(14):4160.
doi: 10.3390/jcm11144160.
Development and Internal Validation of a New Prognostic Model Powered to Predict 28-Day All-Cause Mortality in ICU COVID-19 Patients-The COVID-SOFA Score
Emanuel Moisa[SUP] 1 2 [/SUP], Dan Corneci[SUP] 1 3 [/SUP], Mihai Ionut Negutu[SUP] 2 [/SUP], Cristina Raluca Filimon[SUP] 3 [/SUP], Andreea Serbu[SUP] 3 [/SUP], Mihai Popescu[SUP] 1 4 [/SUP], Silvius Negoita[SUP] 1 2 [/SUP], Ioana Marina Grintescu[SUP] 1 5 [/SUP]
Affiliations
Abstract
Background: The sequential organ failure assessment (SOFA) score has poor discriminative ability for death in severely or critically ill patients with Coronavirus disease 2019 (COVID-19) requiring intensive care unit (ICU) admission. Our aim was to create a new score powered to predict 28-day mortality.
Methods: Retrospective, observational, bicentric cohort study including 425 patients with COVID-19 pneumonia, acute respiratory failure and SOFA score ≥ 2 requiring ICU admission for ≥72 h. Factors with independent predictive value for 28-day mortality were identified after stepwise Cox proportional hazards (PH) regression. Based on the regression coefficients, an equation was computed representing the COVID-SOFA score. Discriminative ability was tested using receiver operating characteristic (ROC) analysis, concordance statistics and precision-recall curves. This score was internally validated.
Results: Median (Q1-Q3) age for the whole sample was 64 [55-72], with 290 (68.2%) of patients being male. The 28-day mortality was 54.58%. After stepwise Cox PH regression, age, neutrophil-to-lymphocyte ratio (NLR) and SOFA score remained in the final model. The following equation was computed: COVID-SOFA score = 10 × [0.037 × Age + 0.347 × ln(NLR) + 0.16 × SOFA]. Harrell's C-index for the COVID-SOFA score was higher than the SOFA score alone for 28-day mortality (0.697 [95% CI; 0.662-0.731] versus 0.639 [95% CI: 0.605-0.672]). Subsequently, the prediction error rate was improved up to 16.06%. Area under the ROC (AUROC) was significantly higher for the COVID-SOFA score compared with the SOFA score for 28-day mortality: 0.796 [95% CI: 0.755-0.833] versus 0.699 [95% CI: 0.653-0.742, p < 0.001]. Better predictive value was observed with repeated measurement at 48 h after ICU admission.
Conclusions: The COVID-SOFA score is better than the SOFA score alone for 28-day mortality prediction. Improvement in predictive value seen with measurements at 48 h after ICU admission suggests that the COVID-SOFA score can be used in a repetitive manner. External validation is required to support these results.
Keywords: ARDS; COVID-19; ICU; NLR; SARS-CoV-2; SOFA; mortality; neutrophil-to-lymphocyte ratio; prognostic score.
. 2022 Jul 18;11(14):4160.
doi: 10.3390/jcm11144160.
Development and Internal Validation of a New Prognostic Model Powered to Predict 28-Day All-Cause Mortality in ICU COVID-19 Patients-The COVID-SOFA Score
Emanuel Moisa[SUP] 1 2 [/SUP], Dan Corneci[SUP] 1 3 [/SUP], Mihai Ionut Negutu[SUP] 2 [/SUP], Cristina Raluca Filimon[SUP] 3 [/SUP], Andreea Serbu[SUP] 3 [/SUP], Mihai Popescu[SUP] 1 4 [/SUP], Silvius Negoita[SUP] 1 2 [/SUP], Ioana Marina Grintescu[SUP] 1 5 [/SUP]
Affiliations
- PMID: 35887924
- DOI: 10.3390/jcm11144160
Abstract
Background: The sequential organ failure assessment (SOFA) score has poor discriminative ability for death in severely or critically ill patients with Coronavirus disease 2019 (COVID-19) requiring intensive care unit (ICU) admission. Our aim was to create a new score powered to predict 28-day mortality.
Methods: Retrospective, observational, bicentric cohort study including 425 patients with COVID-19 pneumonia, acute respiratory failure and SOFA score ≥ 2 requiring ICU admission for ≥72 h. Factors with independent predictive value for 28-day mortality were identified after stepwise Cox proportional hazards (PH) regression. Based on the regression coefficients, an equation was computed representing the COVID-SOFA score. Discriminative ability was tested using receiver operating characteristic (ROC) analysis, concordance statistics and precision-recall curves. This score was internally validated.
Results: Median (Q1-Q3) age for the whole sample was 64 [55-72], with 290 (68.2%) of patients being male. The 28-day mortality was 54.58%. After stepwise Cox PH regression, age, neutrophil-to-lymphocyte ratio (NLR) and SOFA score remained in the final model. The following equation was computed: COVID-SOFA score = 10 × [0.037 × Age + 0.347 × ln(NLR) + 0.16 × SOFA]. Harrell's C-index for the COVID-SOFA score was higher than the SOFA score alone for 28-day mortality (0.697 [95% CI; 0.662-0.731] versus 0.639 [95% CI: 0.605-0.672]). Subsequently, the prediction error rate was improved up to 16.06%. Area under the ROC (AUROC) was significantly higher for the COVID-SOFA score compared with the SOFA score for 28-day mortality: 0.796 [95% CI: 0.755-0.833] versus 0.699 [95% CI: 0.653-0.742, p < 0.001]. Better predictive value was observed with repeated measurement at 48 h after ICU admission.
Conclusions: The COVID-SOFA score is better than the SOFA score alone for 28-day mortality prediction. Improvement in predictive value seen with measurements at 48 h after ICU admission suggests that the COVID-SOFA score can be used in a repetitive manner. External validation is required to support these results.
Keywords: ARDS; COVID-19; ICU; NLR; SARS-CoV-2; SOFA; mortality; neutrophil-to-lymphocyte ratio; prognostic score.