Acil Servise Başvuran COVİD-19 Pnömonili Hastalarda SOFA, qSOFA, CURB-65 ve 4C Mortalite Skorlama Sistemlerinin Prognostik Değeri

Year 2024, Volume: 7 Issue: 4, 165 - 171, 30.12.2024

Yasin Ceylan , Metin Yadigaroğlu , Metin Ocak , Murat Güzel , Vecdi Vahdet Çömez , Alper Yaşar , Şakir Hakan Aksu , Murat Yücel

https://doi.org/10.54996/anatolianjem.1466183

Abstract

Amaç: Bu çalışmada amacımız acil servise başvuran COVID-19 hastalarında; CURB-65, SOFA, qSOFA ve 4C mortalite skorlarının mortalite ile ilişkisini araştırmaktır.

Gereç ve Yöntemler: Bu prospektif gözlemsel çalışmaya; acil servise başvuran, COVID-19 PCR testi pozitif olan ve torax BT’de pnomoni saptanan hastalar dahil edildi.

Bulgular: Çalışmaya 81’i (%50,6) kadın 160 hasta dahil edildi. Hastalar 30 günlük mortalite durumları bakımından incelendiğinde 50 (%32,3) hastanın öldüğü görüldü. SOFA skoruna göre 0-1 puan alan hastaların 2 (%9,1)’sinde, 2-3 puan alan hastaların 13 (%17,8)’ünde, 4-5 puan alan hastaların 9(%32,1)’unda, 6-7 puan alan hastaların 14 (%66,7)’ünde, 8-9 puan alan hastaların 9 (%75)’unda, 10-11 puan alan hastaların (%66,7)’inde ve 12-14 puan alan olan 1 hastada (%100 mortalite geliştiği görüldü. qSOFA skoruna göre; 0 puan alan hastaların 2 (%10)’inde, 1 puan olan hastaların 7 (%13)’sinde, 2 puan alan hastaların 25 (%42,4)’inde, 3 puan alan hastaların 16 (%59,3)’ında mortalite geliştiği görüldü. CURB-65 skoruna göre; 0-1 puan alan hastaların 4 (%19)’ünde, 2 puan alan hastalardan 5 (%9,1)’inde, 3 ve daha fazla puan alan hastalardan 41 (%48,8)’inde mortalite geliştiği görüldü. 4C mortalite skoruna göre; 0-3 puan alan 5 hastada mortalite
gelişmezken, 4-8 puan alanların 1 (%5,3)’inde,9-14 puana alan hastaların 11 (%19,6)’inde, geri kalan hastaların 38 (%47,5)’inde mortalite gelişti. SOFA, qSOFA, CURB-65 ve 4-C Mortalite skorları ile mortalite arasında istatistiksel olarak anlamlı ilişki tespit edildi (hepsi için p<0,001).

Sonuç: COVID-19 hastalarında; SOFA, qSOFA, CURB-65 ve 4CMortalite skorları ölen hastalarda anlamlı derecede yüksek tespit edildi.

Keywords

COVİD-19, SOFA, qSOFA, CURB-65, 4C-mortalite, prognoz

The Prognostic Value of SOFA, qSOFA, CURB-65 and 4C Mortality Scoring Systems in COVID-19 Pneumonia Patients Presenting to the Emergency Department

Abstract

Aim: The aim of this study is to investigate the relationship between mortality and CURB-65, SOFA, qSOFA, and 4C mortality scores in COVID-19 patients presenting to the emergency department.

Material and Methods: This prospective observational study included patients presenting to the emergency department who tested positive for COVID-19 PCR and were diagnosed with pneumonia on chest CT.

Results: A total of 160 patients, of whom 81 (50.6%) were female, were included in the study. Examination of patient mortality within 30 days revealed that 50 (32.3%) patients died. According to the SOFA score, mortality was observed in 2 (9.1%) of patients with scores of 0-1, 13 (17.8%) of those with scores of 2-3, 9(32.1%) of those with scores of 4-5, 14 (66.7%) of those with scores of 6-7, 9 (75%) of those with scores of 8-9, 1 (66.7%) of those with scores of 10-11, and in 1 patient (100%) with a score of 12-14. According to the qSOFA score, mortality was observed in 2 (10%) of patients with a score of 0, 7 (13%) with a score of 1, 25 (42.4%) with a score of 2, and 16 (59.3%) with a score of 3. According to the CURB-65 score, mortality was observed in 4 (19%) of patients with scores of 0-1, 5 (9.1%) of those with a score of 2, and 41 (48.8%) of those with scores of 3 or higher. Regarding the 4C mortality score, mortality was not observed in any of the 5 patients with scores of 0-3, while mortality occurred in 1 (5.3%) of those with scores of 48, 11 (19.6%) of those with scores of 9-14, and in 38 (47.5%) of the remaining patients. Statistically significant relationships were found between SOFA, qSOFA, CURB-65, and 4C mortality scores and mortality (p<0.001 for all).

Conclusion: In COVID-19 patients, SOFA, qSOFA, CURB-65, and 4C mortality scores were significantly higher in deceased patients.

Keywords

COVID-19, SOFA, qSOFA, CURB-65, 4C-mortality, prognosis

References

• Ocak M, Tascanov MB, Yurt NŞ, Yurt YC. A new predictor for indicating clinical severity and prognosis in COVID-19 patients: Frontal QRS-T angle. Am J Emerg Med. 2021 Dec;50:631-5.
• WHO. COVID-19 epidemiological update. Web site. Available at: https://www.who.int/publications/m/item/covid-19-epidemiologicalupdate-16-february-2024. Accessed 12 March 2024.
• Simsek Yurt N, Ocak M, Yurt YC. Epidemiological and clinical characteristics of 3334 cases with prediagnosis coronavirus disease - 2019 (COVID-19) in Turkey. Int J Clin Pract. 2021 Oct;75(10):e14496.
• Natanov D, Avihai B, McDonnell E, et al. Predicting COVID-19 prognosis in hospitalized patients based on early status. mBio. 2023 Oct 31;14(5):e0150823.
• Covino M, De Matteis G, Burzo ML, et al; GEMELLI AGAINST COVID-19 Group. Predicting In-Hospital Mortality in COVID-19 Older Patients with Specifically Developed Scores. J Am Geriatr Soc. 2021 Jan;69(1):37-43.
• Khari S, Salimi Akin Abadi A, Pazokian M, Yousefifard M. CURB-65, qSOFA, and SIRS Criteria in Predicting In-Hospital Mortality of Critically Ill COVID-19 Patients; a Prognostic Accuracy Study. Arch Acad Emerg Med. 2022 May 10;10(1):e36.
• Arora P, Shankar T, Joshi S, et al. Prognostication of COVID-19 patients using ROX index and CURB-65 score - A retrospective observational study. J Family Med Prim Care. 2022 Oct;11(10):6006-14.
• Heydari F, Abbasi S, Shirani K, et al. Predictive performance of qSOFA in confirmed COVID-19 patients presenting to the emergency department. Tzu Chi Med J. 2023 Jan 3;35(2):182-7.
• Abu Elhassan UE, Alqahtani SMA, Al Saglan NS, et al. Utility of the 4C ISARIC mortality score in hospitalized COVID-19 patients at a large tertiary Saudi Arabian center. Multidiscip Respir Med. 2023 Aug 4;18:917.
• Ocho K, Hagiya H, Hasegawa K, Fujita K, Otsuka F. Clinical Utility of 4C Mortality Scores among Japanese COVID-19 Patients: A Multicenter Study. J Clin Med. 2022 Feb 3;11(3):821.
• Işler Y, Kaya H. Relationship of platelet counts, platelet volumes, and Curb-65 scores in the prognosis of COVID-19 patients. Am J Emerg Med. 2022 Jan;51:257-61.
• Lavrentieva A, Kaimakamis E, Voutsas V, Bitzani M. An observational study on factors associated with ICU mortality in Covid-19 patients and critical review of the literature. Sci Rep. 2023 May 13;13(1):7804.
• Bastidas-Goyes AR, Tuta-Quintero E, Aguilar MF, et al. Performance of oxygenation indices and risk scores to predict invasive mechanical ventilation and mortality in COVID-19. BMC Pulm Med. 2024 Feb 2;24(1):68.
• Akdur G, Daş M, Bardakci O, et al. Prediction of mortality in COVID-19 through combing CT severity score with NEWS, qSOFA, or peripheral perfusion index. Am J Emerg Med. 2021 Dec;50:546-52.
• Rubin GD, Ryerson CJ, Haramati LB, et al. The Role of Chest Imaging in Patient Management During the COVID-19 Pandemic: A Multinational Consensus Statement From the Fleischner Society. Chest. 2020 Jul;158(1):106-16.
• Prakash J, Kumar N, Saran K, et al. Computed tomography severity score as a predictor of disease severity and mortality in COVID-19 patients: A systematic review and meta-analysis. J Med Imaging Radiat Sci. 2023 Jun;54(2):364-75.
• Yang Z, Hu Q, Huang F, Xiong S, Sun Y. The prognostic value of the SOFA score in patients with COVID-19: A retrospective, observational study. Medicine (Baltimore). 2021 Aug 13;100(32):e26900.
• Citu C, Citu IM, Motoc A, Forga M, Gorun OM, Gorun F. Predictive Value of SOFA and qSOFA for In-Hospital Mortality in COVID-19 Patients: A Single-Center Study in Romania. J Pers Med. 2022 May 26;12(6):878.
• Nikzad Jamnani A, Gholipour Baradari A, Kargar-Soleimanabad S, Javaheri S. Predictive performance of SOFA (Sequential Organ Failure Assessment) and qSOFA (quick Sequential Organ Failure Assessment) for in-hospital mortality in ICU patients with COVID-19 of referral center in the north of Iran a retrospective study. Ann Med Surg (Lond). 2023 Sep 22;85(11):5414-9.
• Az A, Sogut O, Akdemir T, Ergenc H, Dogan Y, Cakirca M. Impacts of Demographic and Clinical Characteristics on Disease Severity and Mortality in Patients with Confirmed COVID-19. Int J Gen Med. 2021 Jun 29;14:2989-3000.
• Shi Y, Pandita A, Hardesty A, McCarthy M, Aridi J, Weiss ZF, et al. Validation of pneumonia prognostic scores in a statewide cohort of hospitalised patients with COVID-19. Int J Clin Pract. 2021 Mar;75(3):e13926.
• Önal U, Aydın Güçlü Ö, Akalın H, et al. Prognostic factors for COVID-19 patients. J Infect Dev Ctries. 2022 Mar 31;16(3):409-17.
• Knight SR, Ho A, Pius R, et al; ISARIC4C investigators. Risk stratification of patients admitted to hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: development and validation of the 4C Mortality Score. BMJ. 2020 Sep 9;370:m3339.
• Covino M, Sandroni C, Santoro M, et al Predicting intensive care unit admission and death for COVID-19 patients in the emergency department using early warning scores. Resuscitation. 2020 Nov;156:84-91.
• Okuyucu M, Tunç T, Güllü YT, Bozkurt İ, Esen M, Öztürk O. A novel intubation prediction model for patients hospitalized with COVID-19:the OTO-COVID-19 scoring model. Curr Med Res Opin. 2022 Sep;38(9):1509-14.