APACHE-II score most accurate in predicting mortality and ICU admission rate in COVID-19

Past studies have sought to map the prognosis of severely sick COVID-19 patients using scores such as the sequential organ failure assessment (SOFA), the quick sequential organ failure assessment (qSOFA), and new early warning signs (NEWS-2). The acute physiology and chronic health evaluation (APACHE II) has been used in a number of studies to assess critically sick patients needing ventilatory treatment. These scores are designed to assess the morbidity-causing disease's complication sequence, not to forecast the outcome. Nonetheless, there is a strong correlation between organ failure and patient survival.

These four scores were examined and correlated with mortality in COVID-19 patients needing ICU care in a newly published research.m

A prospective cohort study was undertaken on 53 individuals with moderate-to-severe COVID-19. On day 5, the qSOFA, SOFA, APACHE II, and NEWS-2 scores were computed and re-evaluated. A logistic regression analysis was used to determine the determinants of mortality for the qSOFA, SOFA, APACHE II, and NEWS-2 scores.

On day 5, there was a difference in qSOFA, SOFA, APACHE II, and NEWS-2 scores between survivors and nonsurvivors (p0.05), as well as between ICU and non-ICU admission (p0.05). In assessing mortality, the initial NEWS-2 exhibited a greater AUC value than the qSOFA, APACHE II, and SOFA score (0.867; 0.83; 0.822; 0.794). In the intensive care unit, the APACHE II score had a higher AUC value than the SOFA, NEWS-2, or qSOFA scores (0.853; 0.832; 0.813; 0.809). Simultaneously, assessment on day 5 revealed that the qSOFA AUC outperformed the NEWS-2, APACHE II, and SOFA (0.979; 0.965; 0.939; 0.933) in predicting death, whereas the SOFA and APACHE II AUC outperformed the NEWS-2 and qSOFA in predicting ICU admission (0.968; 0.964; 0.939; 0.934). APACHE II on day 5 had the best sensitivity and specificity for predicting death, according to the cutoff score (sensitivity 95.7 percent , specificity 86.7 percent ).

SOFA is a very accurate scoring system that has been extensively used to determine a patient's organ function. The SOFA score is composed of markers relating to respiration (PaO2/FiO2), coagulation (platelet count), the liver (bilirubin), the cardiovascular system (hypertension), the central nervous system, and renal function. The qSOFA score is a simple three-item questionnaire that measures respiratory rate, altered mental state, and systolic blood pressure. As a result of the study above, it was determined that the area under the curve for qSOFA is less accurate than the SOFA score, indicating that SOFA is more accurate. However, the qSOFA score has the potential to serve as a realistic rapid scoring method for assessing the worsening health of critically sick patients. NEWS-2 entails the collection of six physiological data during patient visits. It is associated with the respiratory system, namely oxygen saturation and replenishment. The NEWS-2 score is advantageous in that it may be used to reflect hypoxia and oxygen supplementation. As a result, NEWS-2 may outperform the qSOFA score. The APACHE II score is calculated as the sum of the physiology, age, and chronic conditions components. APACHE II has developed into a reliable predictor of crucial patient outcomes. This number demonstrates the effectiveness, efficacy, and quality of care provided to each patient.

SOFA, qSOFA, NEWS-2, and APACHE II scores seemed to be highly predictive of COVID-19 patients' ICU death after the fifth day. APACHE-II, on the other hand, seems to be the most accurate in predicting both mortality and ICU admission rate.

Reference –

https://www.ijccm.org/abstractArticleContentBrowse/IJCCM/64/26/4/27293/abstractArticle/Article#

Asmarawati TP, Suryantoro SD, Rosyid AN, Marfiani E, Windradi C, Mahdi BA, Sutanto H. Predictive Value of Sequential Organ Failure Assessment (SOFA), Quick Sequential Organ Failure Assessment (qSOFA), Acute Physiology and Chronic Health Evaluation (APACHE II), and New Early Warning Signs (NEWS-2) Scores Estimate Mortality of COVID-19 Patients Requiring Intensive Care Unit (ICU). Indian J Crit Care Med 2022; 26 (4):464-471. DOI: 10.5005/jp-journals-10071-2417