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VOLUME 26 , ISSUE 4 ( April, 2022 ) > List of Articles

Original Article

Predictive Value of Sequential Organ Failure Assessment, Quick Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II, and New Early Warning Signs Scores Estimate Mortality of COVID-19 Patients Requiring Intensive Care Unit

Tri Pudy Asmarawati, Satriyo Dwi Suryantoro, Alfian Nur Rosyid, Erika Marfiani, Choirina Windradi, Bagus Aulia Mahdi, Heri Sutanto

Keywords : APACHE, COVID-19, ICU, Infectious disease, Mortality, NEWS-2, qSOFA, SOFA

Citation Information : Asmarawati TP, Suryantoro SD, Rosyid AN, Marfiani E, Windradi C, Mahdi BA, Sutanto H. Predictive Value of Sequential Organ Failure Assessment, Quick Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II, and New Early Warning Signs Scores Estimate Mortality of COVID-19 Patients Requiring Intensive Care Unit. Indian J Crit Care Med 2022; 26 (4):466-473.

DOI: 10.5005/jp-journals-10071-24170

License: CC BY-NC 4.0

Published Online: 13-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Introduction: Various mortality predictive score models for coronavirus disease-2019 (COVID-19) have been deliberated. We studied how sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA), acute physiology and chronic health evaluation II (APACHE II), and new early warning signs (NEWS-2) scores estimate mortality in COVID-19 patients. Materials and methods: We conducted a prospective cohort study of 53 patients with moderate-to-severe COVID-19. We calculated qSOFA, SOFA, APACHE II, and NEWS-2 on initial admission and re-evaluated on day 5. We performed logistic regression analysis to differentiate the predictors of qSOFA, SOFA, APACHE II, and NEWS-2 scores on mortality. Result: qSOFA, SOFA, APACHE II, and NEWS-2 scores on day 5 exhibited a difference between survivors and nonsurvivors (p <0.05), also between ICU and non-ICU admission (p <0.05). The initial NEWS-2 revealed a higher AUC value than the qSOFA, APACHE II, and SOFA score in estimating mortality (0.867; 0.83; 0.822; 0.794). In ICU, APACHE II score revealed a higher AUC value than the SOFA, NEWS-2, and qSOFA score (0.853; 0.832; 0.813; 0.809). Concurrently, evaluation on day 5 showed that qSOFA AUC had higher scores than the NEWS-2, APACHE II, and SOFA (0.979; 0.965; 0.939; 0.933) in predicting mortality, while SOFA and APACHE II AUC were higher in ICU admission than NEWS-2 and qSOFA (0.968; 0.964; 0.939; 0.934). According to the cutoff score, APACHE II on day 5 revealed the highest sensitivity and specificity in predicting the mortality (sensitivity 95.7%, specificity 86.7%). Conclusion: All scores signify good predictive values on COVID-19 patients mortality following the evaluation on the day 5. Nonetheless, APACHE-II appears to be the best at predicting mortality and ICU admission rate.

  1. Aly MH, Rahman SS, Ahmed WA, Alghamedi MH, Al Shehri AA, Alkalkami AM, et al. Indicators of critical illness and predictors of mortality in COVID-19 patients. IDR 2020;13:1995–2000. DOI: 10.2147/IDR.S261159.
  2. Chatterjee A, Wu G, Primakov S, Oberije C, Woodruff H, Kubben P, et al. Can predicting COVID-19 mortality in a European cohort using only demographic and comorbidity data surpass age-based prediction: an externally validated study. PLoS One 2021;16(4):e0249920. DOI: 10.1371/journal.pone.0249920.
  3. Du R-H, Liang L-R, Yang C-Q, Wang W, Cao T-Z, Li M, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J 2020;55(5):2000524. DOI: 10.1183/13993003.00524-2020.
  4. Ganar A, Potey S. To evaluate and compare ability of two prognostic scoring systems in predicting the mortality of critically ill patients in adult intensive care unit. IJCMR 2019;6(3). DOI: 10.21276/ijcmr.2019.6.3.47.
  5. Shukla U, Chavali S, Mukta P, Mapari A, Vyas A. Initial experience of critically ill patients with COVID-19 in Western India: a case series. Indian J Crit Care Med 2020;24(7):509–513. DOI: 10.5005/jp-journals-10071-23477.
  6. Lambden S, Laterre PF, Levy MM, Francois B. The SOFA score—development, utility and challenges of accurate assessment in clinical trials. Crit Care 2019;23(1):374. DOI: 10.1186/s13054-019-2663-7.
  7. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22(7):707–710. DOI: 10.1007/bf01709751.
  8. Naqvi IH, Mahmood K, Ziaullaha S, Kashif SM, Sharif A. Better prognostic marker in ICU-APACHE II, SOFA or SAP II! Pak J Med Sci 2016;32(5). DOI: 10.12669/pjms.325.10080.
  9. Baker KF, Hanrath AT, Schim van der Loeff I, Kay LJ, Back J, Duncan CJA. National Early Warning Score 2 (NEWS2) to identify inpatient COVID-19 deterioration: a retrospective analysis. Clin Med 2021;21(2):84–89. DOI: 10.7861/clinmed.2020-0688.
  10. De Socio GV, Gidari A, Sicari F, Palumbo M, Francisci D. National Early Warning Score 2 (NEWS2) better predicts critical Coronavirus Disease 2019 (COVID-19) illness than COVID-GRAM, a multi-centre study. Infection 2021. DOI: 10.1007/s15010-021-01620-x.
  11. Carr E, Bendayan R, Bean D, Stammers M, Wang W, Zhang H, et al. Evaluation and improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study. BMC Med 2021;19(1). DOI: 10.1186/s12916-020-01893-3.
  12. Zhang K, Zhang X, Ding W, Xuan N, Tian B, Huang T, et al. The prognostic accuracy of national early warning score 2 on predicting clinical deterioration for patients with COVID-19: a systematic review and meta-analysis. Front Med 2021;8. DOI: 10.3389/fmed.2021.699880.
  13. Liu S, Yao N, Qiu Y, He C. Predictive performance of SOFA and qSOFA for in-hospital mortality in severe novel coronavirus disease. Am J Emerg Med 2020;38(10):2074–2080. DOI: 10.1016/j.ajem.2020.07.019.
  14. Sam KG, Kondabolu K, Pati D, Kamath A, Pradeep Kumar G, Rao PGM. Poisoning severity score, APACHE II and GCS: effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning. J Forensic Leg Med 2009;16(5):239–247. DOI: 10.1016/j.jflm.2008.12.004.
  15. Rojek-Jarmuła A, Hombach R, Krzych ŁJ. APACHE II score cannot predict successful weaning from prolonged mechanical ventilation. Chron Respir Dis 2017;14(3):270–275. DOI: 10.1177/1479972316687100.
  16. Kumar S, Gattani SC, Baheti AH, Dubey A. Comparison of the performance of APACHE II, SOFA, and mNUTRIC scoring systems in critically ill patients: a 2-year cross-sectional study. Indian J Crit Care Med 2020;24(11):1057–1061. DOI: 10.5005/jp-journals-10071-23549.
  17. Raschke RA, Agarwal S, Rangan P, Heise CW, Curry SC. Discriminant accuracy of the SOFA score for determining the probable mortality of patients with COVID-19 pneumonia requiring mechanical ventilation. Journal of the American Medical Association 2021;325(14):1469. DOI: 10.1001/jama.2021.1545.
  18. For Southeast Asia Infectious Disease Clinical Research N, Lie KC, Lau C-Y, Van Vinh Chau N, West TE, Limmathurotsakul D. Utility of SOFA score, management and outcomes of sepsis in Southeast Asia: a multinational multicenter prospective observational study. J Intensive Care 2018;6(1):9. DOI: 10.1186/s40560-018-0279-7.
  19. Liu F, Li L, Xu M, Wu J, Luo D, Zhu Y, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol 2020;127:104370. DOI: 10.1016/j.jcv.2020. 104370.
  20. Elhadi M, Alsoufi A, Abusalama A, Alkaseek A, Abdeewi S, Yahya M, et al. Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: a prospective multi-center cohort study. PLoS One 2021;16(4):e0251085. DOI: 10.1371/journal.pone.0251085.
  21. Liu Y, Chen D, Hou J, Li H, Cao D, Guo M, et al. An inter-correlated cytokine network identified at the center of cytokine storm predicted COVID-19 prognosis. Cytokine 2020:155365. DOI: 10.1016/j.cyto.2020.155365.
  22. Marik PE, Taeb AM. SIRS, qSOFA and new sepsis definition. J Thorac Dis 2017;9(4):943–945. DOI: 10.21037/jtd.2017.03.125.
  23. Koch C, Edinger F, Fischer T, Brenck F, Hecker A, Katzer C, et al. Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients. World J Emerg Surg 2020;15(1). DOI: 10.1186/s13017-020-00343-y.
  24. Akavipat P. Acute Physiology and Chronic Health Evaluation (APACHE) II score–the clinical predictor in neurosurgical intensive care unit. ACC 2019. DOI: 10.20471/acc.2019.58.01.07.
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