Prognostic risk scores for hospitalized COVID-19 patients during the omicron period

Abstract

Aim: During the COVID-19 pandemic, as the number of cases and deaths increased various algorithms were started to used to facilitate patient management. This study aimed to assess the usefulness of the CALL, CHOSEN, HA2T2, and ANDC scores in prognostic assessment and to investigate the establishment of a new scoring system, referred to as CoNTroLAC. Materials and methods: We retrospectively analyzed hospitalized COVID-19 patients. Demographic and laboratory parameters, including comorbidity status, neutrophil-to-lymphocyte ratio (NLR), troponin, LDH, age, and CRP, were assessed in relation to mortality. Mortality distributions across CALL, HA₂T₂, and ANDC risk groups were compared with original reports. A new prognostic score, CoNTroLAC, was constructed using six admission-based parameters using ROC analysis. Results: Mortality was significantly associated with comorbidities, high NLR, elevated troponin, increased LDH, older age, and CRP >10 µg/mL. CALL, HA₂T₂, and ANDC scores demonstrated mortality stratification consistent with findings in their original cohorts. CoNTroLAC, integrating these six parameters, achieved excellent prognostic performance with an AUROC of 0.915. A cut-off score of 12.5 yielded 82.9% sensitivity and 84.7% specificity. Conclusion: In our Omicron-era cohort, CALL, HA₂T₂, and ANDC scores retained prognostic validity comparable to their original derivation studies. The newly developed CoNTroLAC score, incorporating comorbidity, NLR, troponin, LDH, age, and CRP, demonstrated excellent discrimination and may provide a simple, practical tool for early mortality risk stratification in hospitalized COVID-19 patients.

Keywords

• COVID-19
• prognostic scores
• intensive care unit
• mortality

Omikron Döneminde Hastanede Yatan COVID-19 Hastaları İçin Prognostik Risk Puanları

Abstract

Amaç: COVID-19 pandemisi sırasında, vaka ve ölüm sayıları arttıkça hasta yönetimini kolaylaştırmak için çeşitli algoritmalar kullanılmaya başlandı. Bu çalışmanın amacı, CALL, CHOSEN, HA2T2 ve ANDC puanlarının prognostik değerlendirmedeki yararlılığını değerlendirmek ve CoNTroLAC olarak adlandırılan yeni bir puanlama sisteminin oluşturulmasını araştırmaktır. Gereç ve Yöntemler: Hastanede yatan COVID-19 hastalarını retrospektif olarak analiz ettik. Eşlik eden hastalık durumu, nötrofil/lenfosit oranı (NLR), troponin, LDH, yaş ve CRP gibi demografik ve laboratuvar parametreleri mortalite ile ilişkili olarak değerlendirildi. CALL, HA₂T₂ ve ANDC risk gruplarındaki mortalite dağılımları orijinal raporlarla karşılaştırıldı. Altı yatış bazlı parametre kullanılarak ROC analizi kullanılarak yeni bir prognostik skor olan CoNTroLAC oluşturuldu. Bulgular: Mortalite, eşlik eden hastalıklar, yüksek NLR, yüksek troponin, artmış LDH, ileri yaş ve >10 µg/mL CRP ile anlamlı şekilde ilişkiliydi. CALL, HA₂T₂ ve ANDC skorları, orijinal kohortlarındaki bulgularla tutarlı bir mortalite sınıflandırması gösterdi. Bu altı parametreyi entegre eden CoNTroLAC, 0,915'lik bir AUROC ile mükemmel bir prognostik performans elde etti. 12,5'lik bir kesme puanı %82,9 duyarlılık ve %84,7 özgüllük sağladı. Sonuç: Omicron dönemi kohortumuzda, CALL, HA₂T₂ ve ANDC skorları, orijinal türetme çalışmalarına benzer prognostik geçerliliğini korudu. Eşlik eden hastalık, NLR, troponin, LDH, yaş ve CRP'yi içeren yeni geliştirilen CoNTroLAC skoru, mükemmel bir ayrımcılık göstermiştir ve hastaneye yatırılan COVID-19 hastalarında erken mortalite risk sınıflandırması için basit ve pratik bir araç sağlayabilir.

Keywords

• COVID-19
• prognostik skorlar
• yoğun bakım ünitesi
• mortalite

References

1. Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985.
2. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, and Prescott HC. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020;324(8):782-93.
3. Ji D, Zhang D, Xu J, et al. Prediction for Progression Risk in Patients With COVID-19 Pneumonia: The CALL Score. Clin Infect Dis. 2020;71(6):1393-99.
4. Brooks SC, Rosychuk RJ, Perry JJ, et al. Derivation and validation of a clinical decision rule to risk-stratify COVID-19 patients discharged from the emergency department: The CCEDRRN COVID discharge score. J Am Coll Emerg Physicians Open. 2022;3(6):e12868.
5. Manocha KK, Kirzner J, Ying X, et al. Troponin and Other Biomarker Levels and Outcomes Among Patients Hospitalized With COVID-19: Derivation and Validation of the HA(2)T(2) COVID-19 Mortality Risk Score. J Am Heart Assoc. 2021;10(6):e018477.
6. Weng Z, Chen Q, Li S, et al. ANDC: an early warning score to predict mortality risk for patients with Coronavirus Disease 2019. J Transl Med. 2020;18(1):328.
7. Wolfisberg S, Gregoriano C, Struja T, et al. Call, chosen, HA(2)T(2), ANDC: validation of four severity scores in COVID-19 patients. Infection. 2022;50(3):651-59.
8. Sanhueza M, Barrera M, Pedemonte JC, and Rojas L. Validation of the CALL score as a mortality prediction tool in a cohort of hospitalized COVID-19 patients in Chile. Front Med (Lausanne). 2023;10:1164615.

9. Djaharuddin I, Munawwarah S, Nurulita A, Ilyas M, Tabri NA, and Lihawa N. Comorbidities and mortality in COVID-19 patients. Gac Sanit. 2021;35 Suppl 2:S530-S32.
10. Ganaza-Domingues KLT, Ramos-Milare A, Lera-Nonose D, et al. Effect of Comorbidities on the Mortality of Patients With COVID-19: A Systematic Review of Reviews and Meta-Analyses. Rev Med Virol. 2025;35(2):e70024.
11. Seyfi S, Azadmehr A, Ezoji K, et al. Mortality in ICU COVID-19 Patients Is Associated with Neutrophil-to-Lymphocyte Ratio (NLR): Utility of NLR as a Promising Immunohematological Marker. Interdiscip Perspect Infect Dis. 2023;2023:9048749.
12. Toori KU, Qureshi MA, Chaudhry A, and Safdar MF. Neutrophil to lymphocyte ratio (NLR) in COVID-19: A cheap prognostic marker in a resource constraint setting. Pak J Med Sci. 2021;37(5):1435-39.
13. Asperges E, Albi G, Zuccaro V, et al. Dynamic NLR and PLR in Predicting COVID-19 Severity: A Retrospective Cohort Study. Infect Dis Ther. 2023;12(6):1625-40.
14. Vrsalovic M and Vrsalovic Presecki A. Cardiac troponins predict mortality in patients with COVID-19: A meta-analysis of adjusted risk estimates. J Infect. 2020;81(3):e99-e100.
15. Kubiliute I, Urboniene J, Majauskaite F, Bobkov E, Svetikas L, and Jancoriene L. Elevated Cardiac Troponin I as a Mortality Predictor in Hospitalised COVID-19 Patients. Medicina (Kaunas). 2024;60(6)
16. Li F, He M, Zhou M, et al. Association of C-reactive protein with mortality in Covid-19 patients: a secondary analysis of a cohort study. Sci Rep. 2023;13(1):20361.
17. Sadeghi Mofrad S, Boozarjomehri Amnieh S, Pakzad MR, et al. The death rate of COVID-19 infection in different SARS-CoV-2 variants was related to C-reactive protein gene polymorphisms. Sci Rep. 2024;14(1):703.
18. Darden DB, Moore FA, Brakenridge SC, et al. The Effect of Aging Physiology on Critical Care. Crit Care Clin. 2021;37(1):135-50.
19. Papanikolopoulou A, Rapti V, Alexiou P, et al. Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as Prognostic Markers of COVID-19 Disease Irrespective of Immunosuppression Status: A Case-Control Retrospective Single-Center Study. Pathogens. 2025;14(6)
20. Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. J Med Virol. 2020;92(10):1733-34.
21. Garcia-Gasalla M, Berman-Riu M, Pons J, et al. Hyperinflammatory State and Low T1 Adaptive Immune Response in Severe and Critical Acute COVID-19 Patients. Front Med (Lausanne). 2022;9:828678.
22. Rathod BD, Amle D, Khot RS, Prathipati KK, and Joshi PP. Neutrophil-to-Lymphocyte Ratio as a Predictor of Disease Severity and Mortality in Coronavirus Disease 2019: Prospective Study From Central India. Cureus. 2022;14(3):e23696.
23. Bindal A, Patmano M, and Cansun F. Laboratory markers used to predict mortality in severe COVID-19. Ann Med Res. 2022;29(6):545-9.
24. Grifoni E, Valoriani A, Cei F, et al. The CALL Score for Predicting Outcomes in Patients With COVID-19. Clin Infect Dis. 2021;72(1):182-83.
25. Francone M, Iafrate F, Masci GM, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol. 2020;30(12):6808-17.
26. Zhang C, Qin L, Li K, et al. A Novel Scoring System for Prediction of Disease Severity in COVID-19. Front Cell Infect Microbiol. 2020;10:318.
27. Liang W, Liang H, Ou L, et al. Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Intern Med. 2020;180(8):1081-89.