Association of APACHE II and SOFA Scores with Mortality in Severe COVID-19 Patients Undergoing Invasive Mechanical Ventilation: A Retrospective Study

Abstract

OBJECTIVE: Evaluation of organ functions in critically ill patients helps to predict prognosis. Scoring systems in intensive care units (ICU) play a crucial role in comparing predicted versus observed outcomes, allowing evaluation of treatment and assessment of ICU performance. Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores are widely used in the ICU. In our study, we aimed to evaluate the predictive value of APACHE II and SOFA scores in predicting the mortality of severe COVID-19 patients. MATERIALS AND METHODS: Severe COVID-19 patients (≥18 years old) undergoing invasive mechanical ventilation admitted to the ICU between April 1, 2020, and July 1, 2021, were retrospectively analyzed. APACHE II and SOFA scores were calculated within 24 hours after admission. The patients were divided into two groups as survived (Group 1) and nonsurvived (Group 2), and their APACHE II and SOFA scores, demographic, clinical and laboratory data were compared. RESULTS: Totally 212 patients were included. Demographic data were similar in both groups. There was no difference between APACHE II and SOFA scores (p=0.393, p=0.957, respectively). In nonsurvived group, CRP values during admission to the ICU were significantly higher (p=0.001). Conversely, positive tracheal aspirate and blood cultures were higher in survived group (p=0.023, p=0.034, respectively). CONCLUSION: APACHE II is a scoring system accepted to predict mortality in critically ill patients. However, we think that it is ineffective in predicting mortality in severe COVID-19. In these patients, the SOFA score is also ineffective in predicting the prognosis at the first ICU admission, it would be appropriate to evaluate it daily. In our study, high CRP values are associated with mortality. We think that if the scoring systems routinely used in clinical practice will be used in COVID-19 patients, it may be appropriate to add prognostic markers to these scores.

Keywords

• Yoğun bakım skorlama sistemleri
• APACHE
• SOFA
• COVID-19
• prognoz

İnvaziv Mekanik Ventilasyon Uygulanan Ağır COVID-19 Hastalarında APACHE II ve SOFA Skorlarının Mortalite İle İlişkisi: Retrospektif bir çalışma

Abstract

AMAÇ: Kritik hastalarda organ fonksiyonlarının değerlendirilmesi prognozu tahmin etmeye yardımcıdır. Yoğun bakımda (YB) skorlama sistemleri, tahmin edilen ve gözlemlenen sonuçların karşılaştırılmasında, tedavinin değerlendirilmesine çok önemli bir rol oynar ve YB performansının kıyaslanmasına olanak sağlar. Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE) II ve Ardışık Organ Yetmezliği Değerlendirme (SOFA) skorları YB’de yaygın olarak kullanılmaktadır. Çalışmamızda APACHE II ve SOFA skorlarının kritik COVID-19 hastalarında mortaliteyi öngörmedeki etkinliğini değerlendirmeyi amaçladık. GEREÇ VE YÖNTEM: 1 Nisan 2020-1 Temmuz 2021 tarihleri arasında YB’ye kabul edilen invaziv mekanik ventilasyon uygulanan ağır COVID-19 hastaları (≥18 yaş) retrospektif olarak analiz edildi. APACHE II ve SOFA puanları başvurudan sonraki 24 saat içinde hesaplandı. Hastalar yaşayan (Grup 1) ve yaşamayan (Grup 2) olarak iki gruba ayrılarak APACHE II ve SOFA skorları, demografik, klinik ve laboratuar verileri karşılaştırıldı. BULGULAR: Çalışmaya 212 hasta dahil edildi. Demografik veriler iki grupta da benzerdi. APACHE II ve SOFA skorları arasında da fark saptanmadı (sırasıyla p=0.393, p=0.957). Ölen hastalarda YB’ye yatış sırasındaki CRP değerleri anlamlı olarak yüksekti (p=0.001). Yaşayan hastalarda trakeal aspirat ve kan kültürlerinde anlamlı olarak daha fazla üreme mevcuttu (sırasıyla p=0.023, p=0.034). SONUÇ: Kritik hastalarda APACHE II, mortaliteyi öngördüğü kabul edilen bir skorlama sistemidir. Ancak ağır COVID-19 hastalarında mortaliteyi öngörmede etkili olmadığını düşünmekteyiz. SOFA skoru da bu hastalarda ilk YB’ye yatışta prognozu öngörmede etkili değildir, günlük olarak değerlendirilmesi uygun olacaktır. Çalışmamızda yüksek CRP değerleri mortalite ile ilişkili idi. Klinik uygulamalarda rutinde kullanılan skorlama sistemleri COVID-19 hastalarında kullanılacak ise bu skorlara prognostik önemi olan belirteçlerin de eklenmesinin uygun olabileceğini düşünmekteyiz.

Keywords

• Yoğun bakım skorlama sistemleri
• APACHE
• SOFA
• COVID-19
• prognoz

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