Predictive value of the simplified signs scoring system for the severity and prognosis of patients with COVID-19: A multicenter observational study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Sha ¹ , LI Dongze ^1,2 , ZHENG Aiyi ¹ , LI Zhe ¹ , TANG Guo ¹ ,  YAO Rong ^1,2

1. Department of Emergence Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Disaster Medical Center, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

YAO Rong, Email: yaorong@wchscu.cn

Keywords：

Coronavirus disease 2019; risk factor; predictive model; prognosis

DOI：

10.7507/1007-4848.202203002

Video：

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Objective To explore the predictive value of a simplified signs scoring system for the severity and prognosis of patients with coronavirus disease 2019 (COVID-19). Methods Clinical data of 1 605 confirmed patients with COVID-19 from January to May 2020 in 45 hospitals of Sichuan and Hubei Provinces were retrospectively analyzed. The patients were divided into a mild group (n=1150, 508 males, average age of 51.32±16.26 years) and a severe group (n=455, 248 males, average age of 57.63±16.16 years). Results Age, male proportion, respiratory rate, systolic blood pressure and mean arterial pressure in the severe group were higher than those in the mild group (P<0.05). Peripheral oxygen saturation (SpO₂) and Glasgow coma scale (GCS) were lower than those in the mild group (P<0.05). Multivariate logistic regression analysis showed that age, respiratory rate, SpO₂, and GCS were independent risk factors for severe patients with COVID-19. Based on the above indicators, the receiver operating characteristic (ROC) curve analysis showed that the area under the curve of the simplified signs scoring system for predicting severe patients was 0.822, which was higher than that of the quick sequential organ failure assessment (qSOFA) score and modified early warning score (MEWS, 0.629 and 0.631, P<0.001). The ROC analysis showed that the area under the curve of the simplified signs scoring system for predicting death was 0.796, higher than that of qSOFA score and MEWS score (0.710 and 0.706, P<0.001). Conclusion Age, respiratory rate, SpO₂ and GCS are independent risk factors for severe patients with COVID-19. The simplified signs scoring system based on these four indicators may be used to predict patient's risk of severe illness or early death.

Citation： YANG Sha, LI Dongze, ZHENG Aiyi, LI Zhe, TANG Guo, YAO Rong. Predictive value of the simplified signs scoring system for the severity and prognosis of patients with COVID-19: A multicenter observational study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(2): 167-172. doi: 10.7507/1007-4848.202203002 Copy

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13.	Ramos-Rincon JM, Buonaiuto V, Ricci M, et al. Clinical characteristics and risk factors for mortality in very old patients hospitalized with COVID-19 in Spain. J Gerontol A Biol Sci Med Sci, 2021, 76(3): e28-e37.
14.	Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet, 2020, 395(10229): 1054-1062.
15.	Alharthy A, Aletreby W, Faqihi F, et al. Clinical characteristics and predictors of 28-day mortality in 352 critically ill patients with COVID-19: A retrospective study. J Epidemiol Glob Health, 2021, 11(1): 98-104.
16.	Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med, 2020, 8(5): 475-481.
17.	Estenssoro E, Loudet CI, Ríos FG, et al. Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina (SATICOVID): A prospective, multicentre cohort study. Lancet Respir Med, 2021, 9(9): 989-998.
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19.	Akoumianaki E, Vaporidi K, Bolaki M, et al. Happy or silent hypoxia in COVID-19—A misnomer born in the pandemic era. Front Physiol, 2021, 12: 745634.
20.	Chou SH, Beghi E, Helbok R, et al. Global incidence of neurological manifestations among patients hospitalized with COVID-19—A report for the GCS-NeuroCOVID consortium and the ENERGY consortium. JAMA Netw Open, 2021, 4(5): e2112131.

1. Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. Lancet, 2020, 395(10224): 565-574.
2. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA, 2020, 323(11): 1061-1069.
3. Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with COVID-19 using the ISARIC WHO clinical characterisation protocol: Prospective observational cohort study. BMJ, 2020, 369: m1985.
4. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area. JAMA, 2020, 323(20): 2052-2059.
5. 中华人民共和国国家卫生健康委员会. 新型冠状病毒肺炎诊疗方案(试行第八版修订版). 中华临床感染病杂志, 2021, 14(2): 81-88.
6. San I, Gemcioglu E, Baser S, et al. Brescia-COVID Respiratory Severity Scale (BRCSS) and quick SOFA (qSOFA) score are most useful in showing severity in COVID-19 patients. Sci Rep, 2021, 11(1): 21807.
7. Aygun H, Eraybar S. The role of emergency department triage early warning score (TREWS) and modified early warning score (MEWS) to predict in-hospital mortality in COVID-19 patients. Ir J Med Sci, 2022, 191(3): 997-1003.
8. Soto-Mota A, Marfil-Garza BA, Castiello-de Obeso S, et al. Prospective predictive performance comparison between clinical gestalt and validated COVID-19 mortality scores. J Investig Med, 2022, 70(2): 415-420.
9. Kaur S, Bansal R, Kollimuttathuillam S, et al. The looming storm: Blood and cytokines in COVID-19. Blood Rev, 2021, 46: 100743.
10. Smilowitz NR, Kunichoff D, Garshick M, et al. C-reactive protein and clinical outcomes in patients with COVID-19. Eur Heart J, 2021, 42(23): 2270-2279.
11. McElvaney OJ, Curley GF, Rose-John S, et al. Interleukin-6: Obstacles to targeting a complex cytokine in critical illness. Lancet Respir Med, 2021, 9(6): 643-654.
12. Azmy V, Kaman K, Tang D, et al. Cytokine profiles before and after immune modulation in hospitalized patients with COVID-19. J Clin Immunol, 2021, 41(4): 738-747.
13. Ramos-Rincon JM, Buonaiuto V, Ricci M, et al. Clinical characteristics and risk factors for mortality in very old patients hospitalized with COVID-19 in Spain. J Gerontol A Biol Sci Med Sci, 2021, 76(3): e28-e37.
14. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet, 2020, 395(10229): 1054-1062.
15. Alharthy A, Aletreby W, Faqihi F, et al. Clinical characteristics and predictors of 28-day mortality in 352 critically ill patients with COVID-19: A retrospective study. J Epidemiol Glob Health, 2021, 11(1): 98-104.
16. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med, 2020, 8(5): 475-481.
17. Estenssoro E, Loudet CI, Ríos FG, et al. Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina (SATICOVID): A prospective, multicentre cohort study. Lancet Respir Med, 2021, 9(9): 989-998.
18. Youssef Ali Amer A, Wouters F, Vranken J, et al. Vital signs prediction for COVID-19 patients in ICU. Sensors (Basel), 2021, 21(23): 8131.
19. Akoumianaki E, Vaporidi K, Bolaki M, et al. Happy or silent hypoxia in COVID-19—A misnomer born in the pandemic era. Front Physiol, 2021, 12: 745634.
20. Chou SH, Beghi E, Helbok R, et al. Global incidence of neurological manifestations among patients hospitalized with COVID-19—A report for the GCS-NeuroCOVID consortium and the ENERGY consortium. JAMA Netw Open, 2021, 4(5): e2112131.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Predictive value of the simplified signs scoring system for the severity and prognosis of patients with COVID-19: A multicenter observational study

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