Critically ill COVID-19 patients in northeast Brazil: mortality predictors during the first and second waves including SAPS 3

Abstract

Background The Simplified Acute Physiology Score (SAPS) 3 is a reliable score to predict mortality. This study aims to investigate the predictive values of SAPS 3 and other clinical parameters for death in critically ill coronavirus disease 2019 (COVID-19) patients. Methods This is a prospective study in a tertiary hospital for patients who required intensive care due to COVID-19 infection in northeast Brazil. Two distinct groups were constructed according to the epidemiological data: first wave and second wave. The severity of patients admitted was estimated using the SAPS 3 score. Results A total of 767 patients were included: 290 were enrolled in the first wave and 477 in the second wave. Patients in the first wave had more comorbidities, were put on mechanical ventilation and required dialysis and vasopressors more frequently (p<0.05). During the second wave, non-invasive ventilation was more often required (p<0.05). In both periods, older patients and higher SAPS 3 scores on admission were associated with death (p<0.05). Non-invasive ventilation use showed a negative association with death only in the second wave period. In the first wave, the SAPS 3 score was more useful (area under the curve [AUC] 0.897) in predicting death in critically ill COVID-19 patients than in the second wave (AUC 0.810). Conclusion The SAPS 3 showed very reliable predictive values for death during the waves of the COVID-19 pandemic, mostly together with kidney and pulmonary dysfunction.

Prior physical illness predicts death better than acute physiological derangement on intensive care unit admission in COVID-19: A Swedish registry study

“…that patients with low predicted risk of death in reality have higher risk of dying than expected and vice versa in patients with high predicted risk of death. In contrast to a single-center study from Brazil, the present study found SAPS3 to have similar prognostic performance across waves of COVD-19 [ 25 ]. Despite different viral strains, different patient case mixes, pressure on ICU resources and evolving practice of care, SAPS3 performed equally well across the waves of COVID-19.…”

Temporal trends of severity and outcomes of critically ill patients with COVID-19 after the emergence of variants of concern: A comparison of two waves

“…Patients in the second wave were less likely to need vasopressors and RRT during their ICU stay than patients in the first wave, as noted in other studies [ 39 , 40 , 48 ]. These results support the finding that better clinical outcomes in the second wave could be associated with younger age and less severe disease at ICU admission.…”

“…The Gamma variant spread throughout Brazil and other countries and was found to be more transmissible [ 4 – 6 ], having a higher risk of hospitalization [ 44 , 49 ]. While some studies found that it caused more severe disease and increased the risk of death [ 44 , 46 , 50 ], others did not see an increased mortality [ 48 , 51 , 52 ]. It is possible that the elevated daily death counts observed during the second wave in Brazil was due to a combination of increased risk of development of SARI [ 44 ] and lack or delayed access to healthcare and strain on the healthcare system.…”

Endothelial Biomarkers in Critically Ill COVID-19 Patients: Potential Predictors of the Need for Dialysis

“…Some studies support the association between dialysis and elevated mortality [17, 18]. In addition, the correlation between elevated SAPS 3 and pulmonary and renal dysfunction in predicting mortality has been reported [19].…”