Acute Physiology and Chronic Health Evaluation II Score as a Predictor of Hospital Mortality in Patients of Coronavirus Disease 2019
Main result
Of the 154 patients included in the study, 52 were deceased (33.77%). 78 patients were in critical condition (66.67% of whom died).
Elevated numbers were reported for all scores in the dead patients: APACHE II 23.23±6.05 vs 10.87±4.40 (p<0.001), SOFA 4.56±2.81 vs 1.63±1.25 (p<0.001), CURB65 1.44±0.83 vs 0.38±0.51 (p<0.001).
The APACHE II score was found to be a superior score for assessing inpatient mortality compared to the SOFA and CURB65 scores (p<0.001) with a sensitivity of 96.15% and specificity of 86.27%. The three scores were compared with the ROC analysis: the AUC was 0.966 (95% CI: 0.942-0.990) for APACHE II, 0.867 (95% CI: 0.808-0.926) for SOFA and 0.844 (95% CI: 0.784-0.905) for CURB65.
Patients were divided into two groups according to the APACHE II score value: low risk for <17 and high risk for ≥ values. The probability of survival of low-risk patients is significantly higher than that of high-risk patients (p<0.001).
Takeaways
There is evidence that the APACHE II score has a superior predictive capacity for assessing the risk of mortality in COVID-19 patients compared to the SOFA and CRUB65 scores (p<0.001).
The APACHE II score could also be a useful tool to guide medical decisions given that low-risk patients (score<17) have a higher survival rate than high-risk patients (score>17).
Strength of evidence Moderate
Intermediate:
1) Retrospective cohort study
2) Small sample size (n=154)
3) Tongji Hospital is a referral center for the treatment of COVID-19, the severity of symptoms of treated patients and the mortality rate may not reflect that of the population at large.
Objectives
Method
Retrospective cohort study
The study was conducted at Tongji Hospital in Hubei Province, China. Of the 178 potential patients who were hospitalized for COVID-19 between January 10 and February 2020, 154 patients were included in the study and 33.77% died (52 patients). Patients were monitored until February 25, 2020. GCS, APACHE II, SOFA and CURB65 scores were calculated for all patients within 24 hours of hospital admission.
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