Comparison of the effectiveness of the quick COVID-19 severity index and the COVID-19 gram critical illness risk score in identifying critical patients with COVID-19

Abstract

Objectives: This study aimed to compare the effectiveness of the Quick COVID-19 Severity Index (qCSI) and the COVID-GRAM Critical Illness Risk Score (CGCIRS) in identifying critically ill patients with COVID-19 admitted to the emergency department of a tertiary hospital. Methods: Patients over 18 years of age with a positive PCR test who presented to the Emergency Department of Bursa Yüksek İhtisas Training and Research Hospital between 15.03.2020 and 15.03.2021 with COVID-19 findings were retrospectively included in the study. Mortality, qCSI (respiratory rate per minute, oxygen saturation, oxygen demand per minute), and CGCIRS (x-ray abnormality, age, hemoptysis, dyspnea, impaired consciousness, comorbid disease, presence of cancer, neutrophil/lymphocyte ratio, lactate dehydrogenase (LDH) value, direct bilirubin value) were investigated within 1, 7 and 28 days. Results: A total of 1499 patients with a positive COVID-19 PCR test were included in the study. Invasive mechanical ventilation was performed in 44 (2.9%) and non-invasive mechanical ventilation in 63 (4.2%) patients. 57 (3.8%) patients were hospitalized in the intensive care unit (ICU). Mortality occurred in the first 24 hours in 1 (0.1%) and 28 days in 41 (2.7%) patients. Having comorbidities, use of 10 lt/min oxygen, use of high flow oxygen, need for non-invasive and invasive mechanical ventilation, and need for ICU were found to increase 28-day mortality significantly. The qCSI and CGCIRS were found to be significantly different in patients who developed 28-day mortality with qCSI and CGCIRS, respectively (p<0.001), (p<0.001). In the ROC analysis for 28-day mortality, the area under the curve (AUC) value of qCSI was 0.966 [(95% CI: 0.934-0.998), (p<0.001)] and the AUC value of CGCIRS was 0.971 [(95% CI: 0.959-0.983), (p<0.001)]. qCSI had a sensitivity of 97.6% and specificity of 84% with a cut-off value of 4.5 for 28-day mortality; CGCIRS had a sensitivity of 95.1% and specificity of 91.2% with a cut-off value of 116.5 for 28-day mortality. Conclusions: This study demonstrated that both qCSI and CGCIRS have significant predictive capabilities in identifying critical Covid-19 patients over a 28-day period. These scores are valuable for early identification and appropriate management of critically ill patients in the emergency department.

Keywords

• COVID-19
• Prognosis
• Pandemic
• qCSI
• CGCIRS
• Mortality

References

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