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Novel Score for Prediction of Severity and Mortality in Hospitalized Patients with COVID-19

Background: Despite the presence of many scores for the prediction of severity and mortality in COVID-19 patients, predictive accuracies of them are not high enough. Aim: Development of a scale for the prediction of severe condition and in-hospital mortality in hospitalized patients with COVID-19-associated pneumonia. Methods: The study included 135 adult patients hospitalized for COVID-19-associated pneumonia. Risk factors and optimal cut-off criteria for severe/critical condition and in-hospital mortality was established. Results: body mass index (BMI), scales CURB-65 and PSI, history of diabetes mellitus, SpO2 level at admission, leukocyte count, lymphocyte percentage, levels of fasting glucose, alanine aminotransferase, ferritin, soluble IL-2 receptors, IL-6, and ferritin-hemoglobin ratio (FHR) were risk factors for disease progression to severe/critical condition. Logistic regression showed that only SpO2, creatinine, and blood urea nitrogen were independent risk factors of severe/critical condition. Risk factors for in-hospital mortality included age, BMI, scales CURB-65 and PSI, SpO2 level at admission, hemoglobin level, leukocyte count, levels of fasting glucose, creatinine, blood urea nitrogen, ferritin, IL-6, and FHR. However, logistic regression showed no relevant independent risk factor of in-hospital mortality. The novel score has been developed; it included the following parameters: blood pressure, BMI, ferritin level, SpO2, creatinine level, history of arterial hypertension/ prior myocardial infarction / stroke, leukocyte count, elderly, history of diabetes mellitus (acronym “BIFOCALED”). There was good discriminative power of the novel score for severe/critical condition (AUC, 0.806, p<0.001) and in-hospital mortality (AUC, 0.804, p<0.001). The Youden index was 0.47 at the value of >2 points (sensitivity of 84.72%; specificity of 61.90%) for the prediction of severe/critical condition and 0.58 at the value of >5 points (sensitivity of 64.29%; specificity of 93.39%) for prediction of in-hospital mortality. Patients who scored >2 points had a far much higher risk of severe/critical condition (OR, 9.01; 95%CI, 3.97–20.44; p<0.001). In-hospital mortality was significantly higher in patients with >5 points according to the novel score (OR, 25.43; 95%CI, 6.88–93.99; p<0.001). Also, the probability of severe/critical condition and in-hospital mortality depending on the novel score was assessed. Conclusion: The BIFOCALED score may be used for predicting severe/critical condition and in-hospital mortality. The disease progression to severe/critical condition should be suspected in patients who scored >2 points; however, a score of >5 points is associated with high in-hospital mortality.

COVID-19, Score, BIFOCALED, Severity, Mortality

Skakun Oleksiy, Seredyuk Nestor. (2023). Novel Score for Prediction of Severity and Mortality in Hospitalized Patients with COVID-19. International Journal of Infectious Diseases and Therapy, 8(3), 91-100.

Copyright © 2023 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. WHO. WHO COVID-19 dashboard [Internet]. World Health Organization. 2023. Available from: [Accessed 2023 June 29].
2. Wang, H., Paulson, K. R., Pease, S. A., Watson, S., Comfort, H., Zheng, P., Aravkin, A. Y., Bisignano, C., Barber, R. M., Alam, T., Fuller, J. E., May, E. A., Jones, D. P., Frisch, M. E., Abbafati, C., Adolph, C., Allorant, A., Amlag, J. O., Bang-Jensen, B., & Bertolacci, G. J. (2022). Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21. The Lancet, 399 (10334), 1513–1536.
3. Panneer, S., Kantamaneni, K., Palaniswamy, U., Bhat, L., Pushparaj, R. R. B., Nayar, K. R., Soundari Manuel, H., Flower, F. X. L. L., & Rice, L. (2022). Health, Economic and Social Development Challenges of the COVID-19 Pandemic: Strategies for Multiple and Interconnected Issues. Healthcare, 10 (5), 770.
4. Hu, Y., Sun, J., Dai, Z., Deng, H., Li, X., Huang, Q., Wu, Y., Sun, L., & Xu, Y. (2020). Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis. Journal of Clinical Virology, 127, 104371.
5. Hebatallah Hany Assal, Hoda Abdel-Hamid, Magdy, S., Salah, M., Ali, A., Rasha Elkaffas, & Sabry, I. M. (2022). Predictors of severity and mortality in COVID-19 patients. 16 (1).
6. Sitasuwan, T., Phisalprapa, P., Srivanichakorn, W., Washirasaksiri, C., Auesomwang, C., Tinmanee, R., Sayabovorn, N., Chayakulkeeree, M., Phoompoung, P., Mayurasakorn, K., Sookrung, N., Tungtrongchitr, A., Wanitphakdeedecha, R., Muangman, S., Senawong, S., Tangjittipokin, W., Sanpawitayakul, G., Woradetsittichai, D., Nimitpunya, P., Kositamongkol, C., … Chaisathaphol, T. (2022). Early antiviral and supervisory dexamethasone treatment improve clinical outcomes of nonsevere COVID-19 patients. Medicine, 101 (45), e31681.
7. Atluri, K., Aimlin, I., & Arora, S. (2022). Current Effective Therapeutics in Management of COVID-19. Journal of Clinical Medicine, 11 (13), 3838.
8. Rajme-López, S., Martinez-Guerra, B. A., Zalapa-Soto, J., Román-Montes, C. M., Tamez-Torres, K. M., González-Lara, M. F., Hernandez-Gilosul, T., Kershenobich-Stalnikowitz, D., Sifuentes-Osornio, J., Ponce-de-León, A., & Ruíz-Palacios, G. M. (2022). Early Outpatient Treatment With Remdesivir in Patients at High Risk for Severe COVID-19: A Prospective Cohort Study. Open forum infectious diseases, 9 (10), ofac502.
9. Dadras, O., SeyedAlinaghi, S., Karimi, A., Shamsabadi, A., Qaderi, K., Ramezani, M., Mirghaderi, S. P., Mahdiabadi, S., Vahedi, F., Saeidi, S., Shojaei, A., Mehrtak, M., Azar, S. A., Mehraeen, E., & Voltarelli, F. A. (2022). COVID-19 mortality and its predictors in the elderly: A systematic review. Health science reports, 5 (3), e657.
10. Yen, Y. F., Chan, S. Y., Chen, C. C., & Deng, C. Y. (2022). Predictors for Early and Late Death in Adult Patients with COVID-19: A Cohort Study. International journal of environmental research and public health, 19 (6), 3357.
11. Nguyen, N. T., Chinn, J., De Ferrante, M., Kirby, K. A., Hohmann, S. F., & Amin, A. (2021). Male gender is a predictor of higher mortality in hospitalized adults with COVID-19. PloS one, 16 (7), e0254066.
12. Espejo-Paeres, C., Núñez-Gil, I. J., Estrada, V., Fernández-Pérez, C., Uribe-Heredia, G., Cabré-Verdiell, C., Uribarri, A., Romero, R., García-Aguado, M., Fernández-Rozas, I., Becerra-Muñoz, V., Pepe, M., Cerrato, E., Raposeiras-Roubín, S., Barrionuevo-Ramos, M., Aveiga-Ligua, F., Aguilar-Andrea, C., Alfonso-Rodríguez, E., Ugo, F., García-Prieto, J. F. …& Signes-Costa, J. (2021). Impact of smoking on COVID-19 outcomes: a HOPE Registry subanalysis. BMJ nutrition, prevention & health, 4 (1), 285–292.
13. Deng, M., Qi, Y., Deng, L., Wang, H., Xu, Y., Li, Z., Meng, Z., Tang, J., & Dai, Z. (2020). Obesity as a Potential Predictor of Disease Severity in Young COVID-19 Patients: A Retrospective Study. Obesity (Silver Spring, Md.), 28 (10), 1815–1825.
14. Tamara, A., & Tahapary, D. L. (2020). Obesity as a predictor for a poor prognosis of COVID-19: A systematic review. Diabetes & metabolic syndrome, 14 (4), 655–659.
15. Moftakhar, L., Piraee, E., Mohammadi Abnavi, M., Moftakhar, P., Azarbakhsh, H., & Valipour, A. (2021). Epidemiological Features and Predictors of Mortality in Patients with COVID-19 with and without Underlying Hypertension. International journal of hypertension, 2021, 7427500.
16. John, K. J., Mishra, A. K., Ramasamy, C., George, A. A., Selvaraj, V., & Lal, A. (2022). Heart failure in COVID-19 patients: Critical care experience. World journal of virology, 11 (1), 1–19.
17. Atmosudigdo, I. S., Lim, M. A., Radi, B., Henrina, J., Yonas, E., Vania, R., & Pranata, R. (2021). Dyslipidemia Increases the Risk of Severe COVID-19: A Systematic Review, Meta-analysis, and Meta-regression. Clinical medicine insights. Endocrinology and diabetes, 14, 1179551421990675.
18. Schwerzmann, M., Francisco Javier Ruperti-Repilado, Baumgartner, H., Bouma, B. J., Bouchardy, J., Budts, W., Campens, L., Massimo Chessa, Cerro, del, Gabriel, H., Gallego, P., Garcia-Orta, R., Hector Alejandro Keller, Annette Bruun Jensen, Ladouceur, M., Miranda-Barrio, B., Morissens, M., Pasquet, A., Rueda, J., & van. (2021). Clinical outcome of COVID-19 in patients with adult congenital heart disease. 107 (15), 1226–1232.
19. Hariyanto, T. I., Putri, C., Situmeang, R. F. V., & Kurniawan, A. (2021). Dementia is a predictor for mortality outcome from coronavirus disease 2019 (COVID-19) infection. European archives of psychiatry and clinical neuroscience, 271 (2), 393–395.
20. Al-Hussain O. H. (2022). Complications and Comorbidities in COVID-19 Patients: A Comparative study. Cureus, 14 (8), e28614.
21. Gansevoort, R. T., Hilbrands, L. B. CKD is a key risk factor for COVID-19 mortality. Nat Rev Nephrol 16, 705–706 (2020).
22. Vujčić I. (2023). Outcomes of COVID-19 among patients with liver disease. World journal of gastroenterology, 29 (5), 815–824.
23. Xu, J., Xiao, W., Shi, L., Wang, Y., & Yang, H. (2021). Is Cancer an Independent Risk Factor for Fatal Outcomes of Coronavirus Disease 2019 Patients?. Archives of medical research, 52 (7), 755–760.
24. Gerayeli, F. V., Milne, S., Cheung, C., Li, X., Yang, C. W. T., Tam, A., Choi, L. H., Bae, A., & Sin, D. D. (2021). COPD and the risk of poor outcomes in COVID-19: A systematic review and meta-analysis. EClinicalMedicine, 33, 100789.
25. Zheng, Z., Peng, F., Xu, B., Zhao, J., Liu, H., Peng, J., Li, Q., Jiang, C., Zhou, Y., Liu, S., Ye, C., Zhang, P., Xing, Y., Guo, H., & Tang, W. (2020). Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. The Journal of infection, 81 (2), e16–e25.
26. Liu, W., Yang, C., Liao, Y. G., Wan, F., Lin, L., Huang, X., Zhang, B. H., Yuan, Y., Zhang, P., Zhang, X. J., She, Z. G., Wang, L., & Li, H. (2022). Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities. Journal of infection and public health, 15 (1), 13–20.
27. Kilercik, M., Demirelce, Ö., Serdar, M. A., Mikailova, P., & Serteser, M. (2021). A new haematocytometric index: Predicting severity and mortality risk value in COVID-19 patients. PloS one, 16 (8), e0254073.
28. Banchini, F., Cattaneo, G. M., & Capelli, P. (2021). Serum ferritin levels in inflammation: a retrospective comparative analysis between COVID-19 and emergency surgical non-COVID-19 patients. World Journal of Emergency Surgery, 16 (1).
29. Sabaka, P., Koščálová, A., Straka, I., Hodosy, J., Lipták, R., Kmotorková, B., Kachlíková, M., & Kušnírová, A. (2021). Role of interleukin 6 as a predictive factor for a severe course of Covid-19: retrospective data analysis of patients from a long-term care facility during Covid-19 outbreak. BMC infectious diseases, 21 (1), 308.
30. Karimi Shahri, M., Niazkar, H. R., & Rad, F. (2021). COVID-19 and hematology findings based on the current evidences: A puzzle with many missing pieces. International journal of laboratory hematology, 43 (2), 160–168.
31. Lee, J., Park, S. S., Kim, T. Y., Lee, D. G., & Kim, D. W. (2021). Lymphopenia as a Biological Predictor of Outcomes in COVID-19 Patients: A Nationwide Cohort Study. Cancers, 13 (3), 471.
32. Khraise, W. N., Khraise, T. W., Starling Emerald, B., & Allouh, M. Z. (2020). Epidemiologic and Clinical Characteristics of COVID-19 Patients from a Quarantine Center in a Developing Community: A Retrospective Study. International journal of general medicine, 13, 937–944.
33. Smilowitz, N. R., Kunichoff, D., Garshick, M., Shah, B., Pillinger, M., Hochman, J. S., & Berger, J. S. (2021). C-reactive protein and clinical outcomes in patients with COVID-19. European heart journal, 42 (23), 2270–2279.
34. Fawzy, S., Ahmed, M. M., Alsayed, B. A., Mir, R., & Amle, D. (2022). IL-2 and IL-1β Patient Immune Responses Are Critical Factors in SARS-CoV-2 Infection Outcomes. Journal of personalized medicine, 12 (10), 1729.
35. Mohd Zawawi, Z., Kalyanasundram, J., Mohd Zain, R., Thayan, R., Basri, D. F., & Yap, W. B. (2023). Prospective Roles of Tumor Necrosis Factor-Alpha (TNF-α) in COVID-19: Prognosis, Therapeutic and Management. International journal of molecular sciences, 24 (7), 6142.
36. Almayahi, Z. K., Raveendran, A. V., Al Malki, R., Safwat, A., Al Baloshi, M., Abbas, A., Al Salami, A. S., Al Mujaini, S. M., Al Dhuhli, K., & Al Mandhari, S. (2022). Clinical features, laboratory characteristics and risk factors for mortality of COVID-19 patients in a secondary hospital in Oman during the first wave of the SARS-CoV-2 pandemic. Bulletin of the National Research Centre, 46 (1), 139.
37. Jang, H. J., Leem, A. Y., Chung, K. S., Ahn, J. Y., Jung, J. Y., Kang, Y. A., Park, M. S., Kim, Y. S., & Lee, S. H. (2021). Soluble IL-2R Levels Predict in-Hospital Mortality in COVID-19 Patients with Respiratory Failure. Journal of clinical medicine, 10 (18), 4242.
38. Kaya, H., Kaji, M., & Usuda, D. (2021). Soluble interleukin-2 receptor levels on admission associated with mortality in coronavirus disease 2019. International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases, 105, 522–524.
39. Raman, N., Kv, P., Ashta, K. K., Vardhan, V., Thareja, S., J, M., Kumar, A., & Basavaraj (2021). Ferritin and Hemoglobin as Predictors of Fatal Outcome in COVID-19: Two Sides of the Same Coin. The Journal of the Association of Physicians of India, 69 (8), 11–12.
40. Bradley, J., Sbaih, N., Chandler, T. R., Furmanek, S., Ramirez, J. A., & Cavallazzi, R. (2022). Pneumonia Severity Index and CURB-65 Score Are Good Predictors of Mortality in Hospitalized Patients With SARS-CoV-2 Community-Acquired Pneumonia. Chest, 161 (4), 927–936.
41. Lombardi, Y., Azoyan, L., Szychowiak, P., Bellamine, A., Lemaitre, G., Bernaux, M., Daniel, C., Leblanc, J., Riller, Q., Steichen, O., & AP-HP/Universities/INSERM COVID-19 Research Collaboration AP-HP COVID CDR Initiative (2021). External validation of prognostic scores for COVID-19: a multicenter cohort study of patients hospitalized in Greater Paris University Hospitals. Intensive care medicine, 47 (12), 1426–1439.
42. Ministerstvo Okhorony Zdorovia Ukrainy. Derzhavnyi Ekspertnyi Tsentr [Internet]. Protokol «Nadannia medychnoi dopomohy dlia likuvannia koronavirusnoi khvoroby (COVID-19)» [cited 2022 Jul 1]. Available from:
43. Rahman, A., & Sathi, N. J. (2021). Risk factors of the severity of COVID-19: A meta-analysis. International journal of clinical practice, 75 (7), e13916.
44. Ou, M., Zhu, J., Ji, P., Li, H., Zhong, Z., Li, B., Pang, J., Zhang, J., & Zheng, X. (2020). Risk factors of severe cases with COVID-19: a meta-analysis. Epidemiology and infection, 148, e175.
45. Booth, A., Reed, A. B., Ponzo, S., Yassaee, A., Aral, M., Plans, D., Labrique, A., & Mohan, D. (2021). Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis. PloS one, 16 (3), e0247461.
46. Kaeuffer, C., Le Hyaric, C., Fabacher, T., Mootien, J., Dervieux, B., Ruch, Y., Hugerot, A., Zhu, Y. J., Pointurier, V., Clere-Jehl, R., Greigert, V., Kassegne, L., Lefebvre, N., Gallais, F., Covid Alsace Study Group, Meyer, N., Hansmann, Y., Hinschberger, O., Danion, F., & COVID Alsace Study Group (2020). Clinical characteristics and risk factors associated with severe COVID-19: prospective analysis of 1,045 hospitalised cases in North-Eastern France, March 2020. Euro surveillance: bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, 25 (48), 2000895.
47. Li, X., Zhong, X., Wang, Y., Zeng, X., Luo, T., & Liu, Q. (2021). Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis. PloS one, 16 (5), e0250602.
48. Jiang, N., Liu, Y. N., Bao, J., Li, R., Ni, W. T., Tan, X. Y., Xu, Y., Peng, L. P., Wang, X. R., Zeng, Y. M., Liu, D. S., Xue, Q., Li, J. S., Hu, K., Zheng, Y. L., & Gao, Z. C. (2021). Clinical features and risk factors associated with severe COVID-19 patients in China. Chinese medical journal, 134 (8), 944–953.
49. Utulu, R., Ajayi, I. O., Bello, S., Balogun, M. S., Madubueze, U. C., Adeyemi, I. T., Omoju, O. T., Adeke, A. S., Adenekan, A. O., & Iyare, O. (2022). Risk factors for COVID-19 infection and disease severity in Nigeria: a case-control study. The Pan African medical journal, 41, 317.
50. Talebi, S. S., Hosseinzadeh, A., Zare, F., Daliri, S., Jamali Atergeleh, H., Khosravi, A., Goli, S., & Rohani-Rasaf, M. (2022). Risk Factors Associated with Mortality in COVID-19 Patient's: Survival Analysis. Iranian journal of public health, 51 (3), 652–658.
51. Ayón-Aguilar, J., Méndez-Martínez, S., Toledo-Tapia, R., García-Flores, M. A., Mayoral-Ortiz, A., Tlecuitl-Mendoza, N., Toledo-Tapia, M., Ortega-Aguirre, M., & Amaro-Balderas, E. (2022). Influencia de factores de riesgo sobre mortalidad por COVID-19 [Influence of risk factors on mortality from COVID-19]. Revista medica del Instituto Mexicano del Seguro Social, 60 (4), 433–439.
52. Sepandi, M., Taghdir, M., Alimohamadi, Y., Afrashteh, S., & Hosamirudsari, H. (2020). Factors Associated with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis. Iranian journal of public health, 49 (7), 1211–1221.
53. Philip, C., David, A., Mathew, S. K., Sunny, S., Kumar K, V., Jacob, L., Mathew, L., Kumar, S., & Chandy, G. (2022). The Predictive Score for Patients Hospitalized With COVID-19 in Resource-Limited Settings. Cureus, 14 (10), e30373.
54. Subhani, F., Chhotani, A. A., Waheed, S., Zahid, R. O., Azizi, K., & Buksh, A. R. (2022). Development of COVID-19 severity assessment score in adults presenting with COVID-19 to the emergency department. BMC infectious diseases, 22 (1), 576.
55. Sebastian, A., Madziarski, M., Madej, M., Proc, K., Szymala-Pędzik, M., Żórawska, J., Gronek, M., Morgiel, E., Kujawa, K., Skarupski, M., Trocha, M., Rola, P., Gawryś, J., Letachowicz, K., Doroszko, A., Adamik, B., Kaliszewski, K., Kiliś-Pstrusińska, K., Matera-Witkiewicz, A., Pomorski, M. …& Madziarska, K. (2022). The Usefulness of the COVID-GRAM Score in Predicting the Outcomes of Study Population with COVID-19. International journal of environmental research and public health, 19 (19), 12537.
56. Wang, P., Sha, J., Meng, M., Wang, C., Yao, Q., Zhang, Z., Sun, W., Wang, X., Qie, G., Bai, X., Liu, K., & Chu, Y. (2020). Risk factors for severe COVID-19 in middle-aged patients without comorbidities: a multicentre retrospective study. Journal of translational medicine, 18 (1), 461.
57. Wang, M., Wu, D., Liu, C. H., Li, Y., Hu, J., Wang, W., Jiang, W., Zhang, Q., Huang, Z., Bai, L., & Tang, H. (2022). Predicting progression to severe COVID-19 using the PAINT score. BMC infectious diseases, 22 (1), 498.
58. Martín-Rodríguez, F., Sanz-García, A., Ortega, G. J., Delgado-Benito, J. F., García Villena, E., Mazas Pérez-Oleaga, C., López-Izquierdo, R., & Castro Villamor, M. A. (2022). One-on-one comparison between qCSI and NEWS scores for mortality risk assessment in patients with COVID-19. Annals of medicine, 54 (1), 646–654.
59. Giamarellos-Bourboulis, E. J., Poulakou, G., de Nooijer, A., Milionis, H., Metallidis, S., Ploumidis, M., Grigoropoulou, P., Rapti, A., Segala, F. V., Balis, E., Giannitsioti, E., Rodari, P., Kainis, I., Alexiou, Z., Focà, E., Lucio, B., Rovina, N., Scorzolini, L., Dafni, M., Ioannou, S., … Netea, M. G. (2022). Development and validation of SCOPE score: A clinical score to predict COVID-19 pneumonia progression to severe respiratory failure. Cell reports. Medicine, 3 (3), 100560.
60. Cr, P., Vanidassane, I., Pownraj, D., Kandasamy, R., & Basheer, A. (2021). National Early Warning Score 2 (NEWS2) to predict poor outcome in hospitalised COVID-19 patients in India. PloS one, 16 (12), e0261376.