A Comparison of mortality prediction scales accuracy in a single center ICU during 4th Coronavirus wave

Abstract

Introduction: The World Health Organization (WHO) on March 11, 2020, has declared the novel coronavirus (COVID-19) outbreak a global pandemic [1]. Since then, health care system was under pressure and Intensive Care Units (ICU) were overwhelmed by huge infux of patients. Disease severity scoring systems were used to help predict patients’ death at the time on admission to ICU. Objectives: The aim of this study was to compare three disease severity scoring systems and estimate which one is the most accurate for predicting mortality in ICU patients with COVID-19 disease. Methods: We retrospectively evaluated 167 patients, who were admitted to tertiary hospital ICU from 2021 September to 2022 January (4th COVID-19 wave in Lithuania). Patients’ inclusion criteria were age 18 or older and tested positive for SARS-CoV-2 infection, patients who stayed in the ICU less than 24 h were excluded from the study. The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II and 4C ISARIC (4 ISARIC) Mortality Score was calculated upon admission to the Intensive Care Unit. Data was processed by SPSS 26.0 software. The receiver operating characteristic area under the curves (ROC-AUCs) were used to measure the accuracy of disease severity scoring systems. Results: Study cohort included 94 (56.3%) males, age was 60±16 years [range 19–91]. Upon admission to ICU 51 (30.5%) patients were vaccinated. Length of stay in ICU was 5 days [1–50], total length of stay in hospital was 11 days. [1–111]. 106 (63.5%) patients required mechanical ventilation support and 73 (43.7%) patients were treated with renal replacement therapy. All-cause mortality was 54.5%. Median SAPS II, APACHE II, and ISARIC 4C scores on the day of admission were 30.5, 13, 11, respectively. SAPS II AUC value of 0.744 (95% Cl 0.669–0.819; p<0.001). APACHE II AUC value of 0.784 (95% Cl 0.715–0.853; p<0.001). ISARIC 4C value of 0.690 (95% Cl 0.610–0.77; p<0.001). Conclusion: In our study the APACHE II score had the highest accuracy of predicting mortality on first day on admission to the ICU subpopulation with COVID-19 disease during 4th wave of Covid-19 pandemic.