Novel Scoring Systems to Predict the Need for Oxygenation and ICU Care, and Mortality in Hospitalized COVID-19 Patients: A Risk Stratification Tool

Abstract

Introduction: A rapid surge in cases during the COVID-19 pandemic can overwhelm any healthcare system. It is imperative to triage patients who would require oxygen and ICU care, and predict mortality. Specific parameters at admission may help in identifying them.Methodology: A prospective observational study was undertaken in a COVID-19 ward of a tertiary care center. All baseline clinical and laboratory data were captured. Patients were followed till death or discharge. Univariable and multivariable logistic regression was used to find predictors of the need for oxygen, need for ICU care, and mortality. Objective scoring systems were developed for the same using the predictors.Results: The study included 209 patients. Disease severity was mild, moderate, and severe in 98 (46.9%), 74 (35.4%), and 37 (17.7%) patients, respectively. The neutrophil-to-lymphocyte ratio (NLR) >4 was a common independent predictor of the need for oxygen (p<0.001), need for ICU transfer (p=0.04), and mortality (p=0.06). Clinical risk scores were developed (10*c-reactive protein (CRP) + 14.8*NLR + 12*urea), (10*aspartate transaminase (AST) + 15.7*NLR + 14.28*CRP), (10*NLR + 10.1*creatinine) which, if ≥14.8, ≥25.7, ≥10.1 predicted need for oxygenation, need for ICU transfer and mortality with a sensitivity and specificity (81.6%, 70%), (73.3%, 75.7%), (61.1%, 75%), respectively. Conclusion:The NLR, CRP, urea, creatinine, and AST are independent predictors in identifying patients with poor outcomes. An objective scoring system can be used at the bedside for appropriate triaging of patients and utilization of resources.

CRP Monitoring in Early Hospitalization: Implications for Predicting Outcomes in Patients with COVID-19

“…In patients diagnosed with SARS-CoV-2 infection, higher CRP levels have been associated with severe pulmonary pathology and with worse overall outcomes [12][13][14][15][16][18][19][20][21][22]. Moreover, elevated CRP has been used as a predictor of COVID-19 severity and mortality [5][6][7][8][9][10][11]. However, patients with SARS-CoV-2 present for medical attention at differing points in their illness [47].…”

“…However, using MAX CRP over the first 5 days of hospitalization is appropriate given that 71% of patients in our cohort spent at least 5 days in the hospital (median 8 [IQR: 4-12] days). Patients who died stayed longer (10)(11)(12)(13)(14)(15)(16)(17) days) than patients who survived (7)(8)(9)(10)(11) days; p < 0.001), with 84.2% of patients who died staying at least 5 days, vs. 67.6% of patients who survived (p < 0.001). Therefore, regardless of hospitalization outcome, most patients had sufficiently long hospitalizations for a maximum CRP value over 5 days to be relevant.…”

“…Peak CRP levels occur about 48 h after an acute infection with a half-life of 19 h; levels may rise >1000-fold following acute infection or tissue injury [4]. CRP levels have been used for predicting COVID-19 disease severity [5][6][7][8][9][10][11]. Patients who were ultimately intubated, diagnosed with severe disease, or had worsened computer tomography (CT) severity scores often had elevated CRP levels [12][13][14][15][16].…”

Dapsone Lowers Neutrophil to Lymphocyte Ratio and Mortality in COVID-19 Patients Admitted to the ICU

“…In total, 13 studies have been published this year alone (2022) that independently showed that higher NLR in COVID-19 patients entering the hospital was a strong predictor of in-hospital worsening or death [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Chart review showed this to be the case also at our ICU, independently of whether dapsone was given or not.…”