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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. https://doi.org/10.11648/j.ijidt.20230803.13

Copyright © 2023 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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