Mortality Predictive Value of APACHE II and SOFA Scores in COVID-19 Patients in the Intensive Care Unit

Abstract

Background. COVID-19 pandemic has become a global dilemma since December 2019. Are the standard scores, such as acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) score, accurate for predicting the mortality rate of COVID-19 or the need for new scores? We aimed to evaluate the mortality predictive value of APACHE II and SOFA scores in critically ill COVID-19 patients. Methods. In a cohort study, we enrolled 204 confirmed COVID-19 patients admitted to the intensive care units at the Imam Khomeini hospital complex. APACHE II on the first day and daily SOFA scoring were performed. The primary outcome was the mortality rate in the nonsurvived and survived groups, and the secondary outcome was organ dysfunction. Two groups of survived and nonsurvived patients were compared by the chi-square test for categorical variables and an independent sample t-test for continuous variables. We used logistic regression models to estimate the mortality risk of high APACHE II and SOFA scores. Result. Among 204 severe COVID-19 patients, 114 patients (55.9%) expired and 169 patients (82.8%) had at least one comorbidity that 103 (60.9%) of them did not survive ( P = 0.002 ). Invasive mechanical ventilation and its duration were significantly different between survived and nonsurvived groups ( P ≤ 0.001 and P = 0.002 , respectively). Mean APACHE II and mean SOFA scores were significantly higher in the nonsurvived than in the survived group (14.4 ± 5.7 vs. 9.5 ± 5.1, P ≤ 0.001 , 7.3 ± 3.1 vs. 3.1 ± 1.1, P ≤ 0.001 , respectively). The area under the curve was 89.5% for SOFA and 73% for the APACHE II score. Respiratory diseases and malignancy were risk factors for the mortality rate ( P = 0.004 and P = 0.007 , respectively) against diabetes and hypertension. Conclusion. The daily SOFA was a better mortality predictor than the APACHE II in critically ill COVID-19 patients. But they could not predict death with high accuracy. We need new scoring with consideration of the prognostic factors and daily evaluation of changes in clinical conditions.

Risk of Death in Comorbidity Subgroups of Hospitalized COVID-19 Patients Inferred by Routine Laboratory Markers of Systemic Inflammation on Admission: A Retrospective Study

“…Several approaches have been applied to predict the poor prognosis of COVID-19 patients, including the most commonly used scores for assessing multi-organ dysfunction, sepsis and septic shock such as Sequential Organ Failure Assessment (SOFA), quick SOFA (qSOFA), or Acute Physiology and Chronic Health Evaluation (APACHE II) [78][79][80] in patients during their stay in the intensive care unit (ICU). These score systems are based on a fixed set of physiological factors for evaluating the major organ functions not specifically designed for COVID-19.…”

Sequential Organ Failure Assessment (SOFA) Score and Mortality Prediction in Patients With Severe Respiratory Distress Secondary to COVID-19

“…This study was done during the peak of the pandemic. SOFA score was higher in these patients, and they did not find SOFA score as a good predictor of mortality [ 9 ], this could be explained by limited understanding of COVID-19 as well as limited resources during the peak of the pandemic. A retrospective study published in 2021 analyzed the prognostic value of SOFA score in 117 patients with COVID-19 pneumonia [ 18 ].…”

“…Another study published in 2021 put forward that the SOFA score possesses inadequate discriminant accuracy for ventilator triage of COVID-19 patients. However, they retrospectively analyzed only intubated patients when admitted to the ICU; this might skew the AUC for the SOFA score [ 9 ]. Ultimately, our study confirmed that the SOFA scoring for COVID-19 pneumonia had a good correlation with the conventional SOFA scoring system for sepsis patients admitted to the ICU.…”

“…Indeed, the concern showed to be true early on in the H1N1 pandemic, with patients showing higher survivability than expected by SOFA scores [ 6 , 7 ]. The COVID-19 seemed to bring findings opposite, with a higher than average ICU mortality [ 8 , 9 ].…”

Which model is superior in predicting ICU survival: artificial intelligence versus conventional approaches

“…In an epidemiological research and clinical observation, according to the APACHE II score and the mean SOFA value of admission days, the mortality rate for ICU was 21.5 and 7.3%, respectively. The mean daily SOFA score exhibited a stronger predictive performance ( P < 0.001) with a cut-off point of 13 for APACHE II and 5 for the SOFA score [ 29 ]. In another study, Costa e Silva et al reported that SOFA with a cut-off point of 4 and a 75% area under the ROC curve could more accurately predict mortality of liver cirrhosis patients than APACHE II with a cut-off point of 17 and the area under the ROC curve of 69% [ 30 ].…”