Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-10T07:04:37.606Z Has data issue: false hasContentIssue false
  • English
  • Français

Early Warning Scores at Time of ICU Admission to Predict Mortality in Critically Ill COVID-19 Patients

Published online by Cambridge University Press:  18 June 2021

Asha Tyagi ,
Surbhi Tyagi ,
Ananya Agrawal ,
Aparna Mohan ,
Devansh Garg Open the ORCID record for Devansh Garg [Opens in a new window] ,
Rashmi Salhotra ,
Ashok Kumar Saxena  and
Ashish Goel
Asha Tyagi
Affiliation:
Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi, India
Surbhi Tyagi
Affiliation:
Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi, India
Ananya Agrawal
Affiliation:
Hamdard Institute of Medical Sciences & Research, New Delhi, India
Aparna Mohan
Affiliation:
Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi, India
Devansh Garg*
Affiliation:
Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi, India
Rashmi Salhotra
Affiliation:
Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi, India
Ashok Kumar Saxena
Affiliation:
Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi, India
Ashish Goel
Affiliation:
Department of Medicine, University College of Medical Sciences & GTB Hospital, Delhi, India
*
Corresponding author: Devansh Garg, Email: devansqew@gmail.com.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To assess ability of National Early Warning Score 2 (NEWS2), systemic inflammatory response syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), and CRB-65 calculated at the time of intensive care unit (ICU) admission for predicting ICU mortality in patients of laboratory confirmed coronavirus disease 2019 (COVID-19) infection.

Methods:

This prospective data analysis was based on chart reviews for laboratory confirmed COVID-19 patients admitted to ICUs over a 1-mo period. The NEWS2, CRB-65, qSOFA, and SIRS were calculated from the first recorded vital signs upon admission to ICU and assessed for predicting mortality.

Results:

Total of 140 patients aged between 18 and 95 y were included in the analysis of whom majority were >60 y (47.8%), with evidence of pre-existing comorbidities (67.1%). The most common symptom at presentation was dyspnea (86.4%). Based upon the receiver operating characteristics area under the curve (AUC), the best discriminatory power to predict ICU mortality was for the CRB-65 (AUC: 0.720 [95% confidence interval [CI]: 0.630-0.811]) followed closely by NEWS2 (AUC: 0.712 [95% CI: 0.622-0.803]). Additionally, a multivariate Cox regression model showed Glasgow Coma Scale score at time of admission (P < 0.001; adjusted hazard ratio = 0.808 [95% CI: 0.715-0.911]) to be the only significant predictor of ICU mortality.

Conclusions:

CRB-65 and NEWS2 scores assessed at the time of ICU admission offer only a fair discriminatory value for predicting mortality. Further evaluation after adding laboratory markers such as C-reactive protein and D-dimer may yield a more useful prediction model. Much of the earlier data is from developed countries and uses scoring at time of hospital admission. This study was from a developing country, with the scores assessed at time of ICU admission, rather than the emergency department as with existing data from developed countries, for patients with moderate/severe COVID-19 disease. Because the scores showed some utility for predicting ICU mortality even when measured at time of ICU admission, their use in allocation of limited ICU resources in a developing country merits further research.

Keywords

COVID-19emergency warning scoresNEWS2CRB-65ICU mortality
Type
Brief Report
Information
Disaster Medicine and Public Health Preparedness , Volume 16 , Issue 6 , December 2022 , pp. 2371 - 2375
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

WHO. COVID-19 Clinical management. Living guidance. 25 January 2021. https://apps.who.int/iris/bitstream/handle/10665/338882/WHO-2019-nCoV-clinical-2021.1-eng.pdf. Accessed February 19, 2021.Google Scholar
Myrstad, M, Ihle-Hansen, H, Tveita, AA, et al. 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. doi: 10.1186/s13049-020-00764-3 CrossRefGoogle ScholarPubMed
Hu, H, Yao, N, Qiu, Y. Predictive value of 5 early warning scores for critical COVID-19 patients. Disaster Med Public Health Prep. 2020:1-8. doi: 10.1017/dmp.2020.324 Google Scholar
Covino, M, Matteis, GD, Burzo, ML, et al. Predicting in-hospital mortality in COVID-19 older patients with specifically developed scores. J Am Geriatr Soc. 2021;69(1):37-43. doi: 10.1111/jgs.16956 CrossRefGoogle ScholarPubMed
Hu, H, Yao, N, Qiu, Y. Comparing rapid scoring systems in mortality prediction of critically ill patients with novel coronavirus disease. Acad Emerg Med. 2020;27(6):461-468. doi: 10.1111/acem.13992 CrossRefGoogle ScholarPubMed
Jang, JG, Hur, J, Hong, KS, et al. 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. doi: 10.3346/jkms.2020.35.e234 CrossRefGoogle ScholarPubMed
Singer, M, Deutschman, CS, Seymour, CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi: 10.1001/jama.2016.0287 CrossRefGoogle ScholarPubMed
No Authors Listed. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20(6):864-874.CrossRefGoogle Scholar
Lim, WS, van der Eerden, MM, Laing, R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377-382. doi: 10.1136/thorax.58.5.377 CrossRefGoogle ScholarPubMed
Fan, J, Upadhye, S, Worster, A. Understanding receiver operating characteristic (ROC) curves. CJEM. 2006;8(1):19-20. doi: 10.1017/s1481803500013336 CrossRefGoogle ScholarPubMed
Liu, F-Y, Sun, X-L, Zhang, Y, et al. Evaluation of the risk prediction tools for patients with coronavirus disease 2019 in Wuhan, China: a single-centered, retrospective, observational study. Crit Care Med. 2020;48(11):e1004-e1011. doi: 10.1097/CCM.0000000000004549 CrossRefGoogle Scholar
Clinical management protocol: COVID-19. https://www.mohfw.gov.in/pdf/UpdatedDetailedClinicalManagementProtocolforCOVID19adultsdated24052021.pdf. Accessed February 22, 2021.Google Scholar