Predicting In-Hospital Mortality in COVID-19 Older Patients with Specifically Developed Scores

Marcello Covino; Giuseppe De Matteis; Maria Livia Burzo; Andrea Russo; Evelina Forte; Annamaria Carnicelli; Andrea Piccioni; Benedetta Simeoni; Antonio Gasbarrini; Francesco Franceschi; Claudio Sandroni; GEMELLI AGAINST COVID-19 Group

doi:10.1111/jgs.16956

Predicting In-Hospital Mortality in COVID-19 Older Patients with Specifically Developed Scores

J Am Geriatr Soc. 2021 Jan;69(1):37-43. doi: 10.1111/jgs.16956. Epub 2020 Nov 30.

Affiliations

¹ Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
² Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
³ Geriatrics Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁴ Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁵ Università Cattolica del Sacro Cuore, Rome, Italy.
⁶ Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Abstract

Background/objectives: Several scoring systems have been specifically developed for risk stratification in COVID-19 patients.

Design: We compared, in a cohort of confirmed COVID-19 older patients, three specifically developed scores with a previously established early warning score. Main endpoint was all causes in-hospital death.

Setting: This is a single-center, retrospective observational study, conducted in the Emergency Department (ED) of an urban teaching hospital, referral center for COVID-19.

Participants: We reviewed the clinical records of the confirmed COVID-19 patients aged 60 years or more consecutively admitted to our ED over a 6-week period (March 1st to April 15th, 2020). A total of 210 patients, aged between 60 and 98 years were included in the study cohort.

Measurements: International Severe Acute Respiratory Infection Consortium Clinical Characterization Protocol-Coronavirus Clinical Characterization Consortium (ISARIC-4C) score, COVID-GRAM Critical Illness Risk Score (COVID-GRAM), quick COVID-19 Severity Index (qCSI), National Early Warning Score (NEWS).

Results: Median age was 74 (67-82) and 133 (63.3%) were males. Globally, 42 patients (20.0%) deceased. All the score evaluated showed a fairly good predictive value with respect to in-hospital death. The ISARIC-4C score had the highest area under ROC curve (AUROC) 0.799 (0.738-0.851), followed by the COVID-GRAM 0.785 (0.723-0.838), NEWS 0.764 (0.700-0.819), and qCSI 0.749 (0.685-0.806). However, these differences were not statistical significant.

Conclusion: Among the evaluated scores, the ISARIC-4C and the COVID-GRAM, calculated at ED admission, had the best performance, although the qCSI had similar efficacy by evaluating only three items. However, the NEWS, already widely validated in clinical practice, had a similar performance and could be appropriate for older patients with COVID-19.

Keywords: COVID-19; COVID-GRAM; ISARIC-4C; NEWS; qCSI.

Publication types

Observational Study

MeSH terms

Aged
COVID-19 / mortality*
COVID-19 / therapy
Cohort Studies
Critical Illness / mortality*
Critical Illness / therapy
Emergency Service, Hospital
Female
Hospital Mortality*
Humans
Italy
Male
Middle Aged
Retrospective Studies
Severity of Illness Index*