Predicting severe COVID-19 in the Emergency Department

Aleksander Rygh Holten, Kristin Grotle Nore, Caroline Emilie Van Woensel Kooy Tveiten, Theresa Mariero Olasveengen, Kristian Tonby, Aleksander Rygh Holten, Kristin Grotle Nore, Caroline Emilie Van Woensel Kooy Tveiten, Theresa Mariero Olasveengen, Kristian Tonby

Abstract

Background: COVID-19 may lead to severe disease, requiring intensive care treatment and challenging the capacity of health care systems. The aim of this study was to compare the ability of commonly used scoring systems for sepsis and pneumonia to predict severe COVID-19 in the emergency department.

Methods: Prospective, observational, single centre study in a secondary/tertiary care hospital in Oslo, Norway. Patients were assessed upon hospital admission using the following scoring systems; quick Sequential Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome criteria (SIRS), National Early Warning Score 2 (NEWS2), CURB-65 and Pneumonia Severity index (PSI). The ratio of arterial oxygen tension to inspiratory oxygen fraction (P/F-ratio) was also calculated. The area under the receiver operating characteristics curve (AUROC) for each scoring system was calculated, along with sensitivity and specificity for the most commonly used cut-offs. Severe disease was defined as death or treatment in ICU within 14 days.

Results: 38 of 175 study participants developed severe disease, 13 (7%) died and 29 (17%) had a stay at an intensive care unit (ICU). NEWS2 displayed an AUROC of 0.80 (95% confidence interval 0.72-0.88), CURB-65 0.75 (0.65-0.84), PSI 0.75 (0.65-0.84), SIRS 0.70 (0.61-0.80) and qSOFA 0.70 (0.61-0.79). NEWS2 was significantly better than SIRS and qSOFA in predicating severe disease, and with a cut-off of5 points, had a sensitivity and specificity of 82% and 60%, respectively.

Conclusion: NEWS2 predicted severe COVID-19 disease more accurately than SIRS and qSOFA, but not significantly better than CURB65 and PSI. NEWS2 may be a useful screening tool in evaluating COVID-19 patients during hospital admission.

Trial registration: : ClinicalTrials.gov Identifier: NCT04345536. (https://ichgcp.net/clinical-trials-registry/NCT04345536).

Keywords: COVID- 19; CURB-65; National Early Warning Score2 (NEWS2); Pneumonia Severity Index (PSI); Systemic Inflammatory Response Syndrome (SIRS); qSOFA.

© 2020 The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart over study participants.
Fig. 2
Fig. 2
Receiver operating characteristics (ROC) curve for predicting severe COVID-19. The curves for NEWS2, qSOFA, SIRS, CURB65 and PSI are based on 169 patients (38 severe, and 131 non-severe), whereas the curve for P/F-ratio are based 136 patients (37 severe and 99 non-severe).

References

    1. Lu H., Stratton C.W., Tang Y.W. Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol. 2020;92(4):401–402.
    1. Tanne J.H., Hayasaki E., Zastrow M., Pulla P., Smith P., Rada A.G. Covid-19: how doctors and healthcare systems are tackling coronavirus worldwide. BMJ (Clin Res Ed) 2020;368:m1090.
    1. Ji Y., Ma Z., Peppelenbosch M.P., Pan Q. Potential association between COVID-19 mortality and health-care resource availability. Lancet Glob Health. 2020;8(4):e480.
    1. Maves R.C., Downar J., Dichter J.R. Triage of scarce critical care resources in COVID-19: an implementation guide for regional allocation: an expert panel report of the Task Force for Mass Critical Care and the American College of Chest Physicians. Chest. 2020;158(1):212–225.
    1. Wu Z., McGoogan J.M. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the chinese center for disease control and prevention. JAMA. 2020;323(13):1239–1242.
    1. Grasselli G., Zangrillo A., Zanella A. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574–1581.
    1. Richardson S., Hirsch J.S., Narasimhan M. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA. 2020;323(20):2052–2059.
    1. Ferreira M., Blin T., Collercandy N. Critically ill SARS-CoV-2-infected patients are not stratified as sepsis by the qSOFA. Ann Intensive Care. 2020;10(1):43.
    1. Ihle-Hansen H., Berge T., Tveita A. COVID-19: symptoms, course of illness and use of clinical scoring systems for the first 42 patients admitted to a Norwegian local hospital. Tidsskr Nor Laegeforen. 2020;140(7)
    1. Gidari A., De Socio G.V., Sabbatini S., Francisci D. Predictive value of National Early Warning Score 2 (NEWS2) for intensive care unit admission in patients with SARS-CoV-2 infection. Infect Dis (Lond) 2020:1–7.
    1. Jang J.G., Hur J., Hong K.S., Lee W., Ahn J.H. Prognostic accuracy of the SIRS, qSOFA, and NEWS for early detection of clinical deterioration in SARS-CoV-2 infected patients. J Korean Med Sci. 2020;35(25):e234.
    1. Su Y., Tu G.W., Ju M.J. Comparison of CRB-65 and quick sepsis-related organ failure assessment for predicting the need for intensive respiratory or vasopressor support in patients with COVID-19. J Infect. 2020;81(4):647–679.
    1. Nguyen Y., Corre F., Honsel V. Applicability of the CURB-65 pneumonia severity score for outpatient treatment of COVID-19. J Infect. 2020;81(3):e96–e98.
    1. Satici C., Demirkol M.A., Altunok E.S. Performance of Pneumonia Severity Index and CURB-65 in predicting 30-day mortality in patients with COVID-19. Int J Infect Dis. 2020;98:84–89.
    1. Myrstad M., Ihle-Hansen H., Tveita A.A. National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19 — a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2020;28(1):66.
    1. Xie J., Tong Z., Guan X., Du B., Qiu H., Slutsky A.S. Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Med. 2020;46(5):837–840.
    1. Seymour C.W., Liu V.X., Iwashyna T.J. Assessment of clinical criteria for sepsis: For the third international consensus definitions for sepsis and septic shock (sepsis-3) JAMA. 2016;315(8):762–774.
    1. Bone R.C., Balk R.A., Cerra F.B. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–1655.
    1. Physicians RCo . 2017. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party.
    1. Lim W.S., van der Eerden M.M., Laing R. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377–382.
    1. Bauer T.T., Ewig S., Marre R., Suttorp N., Welte T. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006;260(1):93–101.
    1. Fine M.J., Auble T.E., Yealy D.M. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243–250.
    1. Metlay J.P., Waterer G.W., Long A.C. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the american thoracic society and infectious diseases society of america. Am J Respir Crit Care Med. 2019;200(7):e45–e67.
    1. Ranieri V.M., Rubenfeld G.D., Thompson B.T. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–2533.
    1. Vincent J.-L., Moreno R., Takala J. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22(7):707–710.
    1. Cohen J.F., Korevaar D.A., Altman D.G. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 2016;6(11)
    1. Mellhammar L., Linder A., Tverring J. NEWS2 is superior to qSOFA in detecting sepsis with organ dysfunction in the emergency department. J Clin Med. 2019;8(8)
    1. Churpek M.M., Snyder A., Han X. Quick sepsis-related organ failure assessment, systemic inflammatory response syndrome, and early warning scores for detecting clinical deterioration in infected patients outside the intensive care unit. Am J Respir Crit Care Med. 2017;195(7):906–911.
    1. Wynants L., Van Calster B., Collins G.S. Prediction models for diagnosis and prognosis of covid-19 infection: Systematic review and critical appraisal. BMJ. 2020;369:m1328.
    1. Liang W., Liang H., Ou L. Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19. JAMA Intern Med. 2020;180(8):1081–1089.
    1. Wu C., Chen X., Cai Y. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934–943.
    1. Jiang X., Coffee M., Bari A. Towards an artificial intelligence framework for data-driven prediction of coronavirus clinical severity. Comput Mater Continua. 2020;63(1):537–551.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera