Important Scoring Systems for Assessing the Severity of COVID-19 Based on COVID-19-related Deaths in Wuhan, China

Overview

Journal Emerg Crit Care Med

Publisher Wolters Kluwer

Specialty Critical Care

Date 2024 Apr 17

PMID 38630113

Authors

Feihong Yang

Hao Zou

Jiaohong Gan

Zhongxiang Zhang

Yan Zhao

Cheng Jiang

Jian Xia

Affiliations

Soon will be listed here.

Abstract

Background: This study aimed to investigate the clinical characteristics of 21 deaths and evaluate potential factors affecting disease severity and mortality risk in patients with coronavirus disease (COVID-19).

Methods: This retrospective analysis assessed clinical data of 21 patients who died owing to COVID-19. Disease severity and mortality risk were assessed using Acute Physiology and Chronic Health Evaluation II (APACHE II); Sepsis-related Organ Failure Assessment (SOFA); multilobular infiltration, hypo-lymphocytosis, bacterial coinfection, smoking history, hypertension and age (MuLBSTA); and pneumonia severity index (PSI) scores.

Results: The mean age of the patients was 66 ± 14 years and 15 (71.4%) patients were men. Sixteen (76.2%) patients had chronic medical illnesses. Twelve (57.1%) patients were overweight. Decreased lymphocyte proportions were observed in 17 (81.0%) patients on admission. Elevated D-dimer levels were observed in 11 (52.4%) patients, and the levels significantly increased when pneumonia deteriorated. The initial APACHE II and SOFA scores demonstrated that 18 (85.7%) and 13 (61.9%) patients, respectively, were in the middle-risk level. MuLBSTA and PSI scores after admission were associated with higher risks of mortality in 13 (61.9%) patients. Most patients developed organ failure and subsequently died.

Conclusions: Older, overweight, male patients with a history of chronic illnesses and continuously decreased lymphocyte proportions and increased D-dimer levels might have higher risks of death owing to COVID-19. The combination of general scoring (SOFA) and pneumonia-specific scoring (MuLBSTA and PSI) systems after admission might be sensitive in assessing the mortality risk of patients with COVID-19 who are in critical condition.

References

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J . Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020; 323(11):1061-1069. PMC: 7042881. DOI: 10.1001/jama.2020.1585. View

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J . Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 382(18):1708-1720. PMC: 7092819. DOI: 10.1056/NEJMoa2002032. View

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z . 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. PMC: 7270627. DOI: 10.1016/S0140-6736(20)30566-3. View

Channappanavar R, Fett C, Mack M, Ten Eyck P, Meyerholz D, Perlman S . Sex-Based Differences in Susceptibility to Severe Acute Respiratory Syndrome Coronavirus Infection. J Immunol. 2017; 198(10):4046-4053. PMC: 5450662. DOI: 10.4049/jimmunol.1601896. View

Gu J, Gong E, Zhang B, Zheng J, Gao Z, Zhong Y . Multiple organ infection and the pathogenesis of SARS. J Exp Med. 2005; 202(3):415-24. PMC: 2213088. DOI: 10.1084/jem.20050828. View

Chen X, Chughtai A, Dyda A, MacIntyre C . Comparative epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia and South Korea. Emerg Microbes Infect. 2017; 6(6):e51. PMC: 5520315. DOI: 10.1038/emi.2017.40. View

Guo L, Wei D, Zhang X, Wu Y, Li Q, Zhou M . Clinical Features Predicting Mortality Risk in Patients With Viral Pneumonia: The MuLBSTA Score. Front Microbiol. 2019; 10:2752. PMC: 6901688. DOI: 10.3389/fmicb.2019.02752. View

Knaus W, Draper E, Wagner D, Zimmerman J . APACHE II: a severity of disease classification system. Crit Care Med. 1985; 13(10):818-29. View

Claushuis T, van Vught L, Scicluna B, Wiewel M, Klein Klouwenberg P, Hoogendijk A . Thrombocytopenia is associated with a dysregulated host response in critically ill sepsis patients. Blood. 2016; 127(24):3062-72. DOI: 10.1182/blood-2015-11-680744. View

10.

Badawi A, Ryoo S . Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis. Int J Infect Dis. 2016; 49:129-33. PMC: 7110556. DOI: 10.1016/j.ijid.2016.06.015. View

11.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y . Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395(10223):507-513. PMC: 7135076. DOI: 10.1016/S0140-6736(20)30211-7. View

12.

Hoffmann M, Kleine-Weber H, Schroeder S, Kruger N, Herrler T, Erichsen S . SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020; 181(2):271-280.e8. PMC: 7102627. DOI: 10.1016/j.cell.2020.02.052. View

13.

Luo W, Yu H, Gou J, Li X, Sun Y, Li J . Histopathologic Findings in the Explant Lungs of a Patient With COVID-19 Treated With Bilateral Orthotopic Lung Transplant. Transplantation. 2020; 104(11):e329-e331. DOI: 10.1097/TP.0000000000003412. View

14.

Outinen T, Laine O, Makela S, Porsti I, Huhtala H, Vaheri A . Thrombocytopenia associates with the severity of inflammation and variables reflecting capillary leakage in Puumala Hantavirus infection, an analysis of 546 Finnish patients. Infect Dis (Lond). 2016; 48(9):682-7. DOI: 10.1080/23744235.2016.1192719. View

15.

Zhang B, Zhou X, Qiu Y, Song Y, Feng F, Feng J . Clinical characteristics of 82 cases of death from COVID-19. PLoS One. 2020; 15(7):e0235458. PMC: 7347130. DOI: 10.1371/journal.pone.0235458. View

16.

Fine M, Auble T, Yealy D, Hanusa B, Weissfeld L, Singer D . A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997; 336(4):243-50. DOI: 10.1056/NEJM199701233360402. View

17.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

18.

Rodelo J, De La Rosa G, Valencia M, Ospina S, Arango C, I Gomez C . D-dimer is a significant prognostic factor in patients with suspected infection and sepsis. Am J Emerg Med. 2012; 30(9):1991-9. DOI: 10.1016/j.ajem.2012.04.033. View

19.

Liu W, Zhao M, Liu K, Xu K, Wong G, Tan W . T-cell immunity of SARS-CoV: Implications for vaccine development against MERS-CoV. Antiviral Res. 2016; 137:82-92. PMC: 7113894. DOI: 10.1016/j.antiviral.2016.11.006. View

20.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506. PMC: 7159299. DOI: 10.1016/S0140-6736(20)30183-5. View