Performance of APACHE II, SOFA, and CURB-65 for death prognosis in COVID-19 critical patients: A prospective cohort study

Abstract

Rationale

The identification of patients with high risk of death makes individual decision making more efficient, optimizing resources and improving the quality of the medical attention. The prognostic utility of APACHE II, SOFA, and CURB-65 in critical COVID-19 has not yet been determined.

Objective

The present work intends to validate these scoring systems for the prediction of death within 60 days in patients hospitalized in intensive care with COVID-19.

Methods

A prospective cohort was conducted which included adults with confirmed COVID-19 hospitalized in ICU. The scores were calculated by building ROC curves and calculating the areas under the curve and the curves of decision analysis.

Measurements

The operating characteristics and Kaplan Meier curves were calculated.

Results

320 patients between July and December 2020 were included, mortality within 60 days was 49.7%. CURB-65 had an AUC of 0.68 (CI 0.62–0.74), sensitivity 73.6%, and specificity 55.9%; APACHE-II had an AUC of 0.65 (CI 0.60–0.71), sensitivity 51.6%, and specificity 70.2%; and SOFA had an AUC of 0.70 (CI 0.64–0.75), sensitivity 83.6%, and specificity 52.2%. The three scoring systems obtained values of p < 0.001 for the LongRank test in the survival curves, offering moderate increments in the net benefit.

Conclusion

The scoring systems for clinical prediction CURB-65, APACHE II, and SOFA exhibited moderate discriminatory ability for death within 60 days in patients with COVID-19 hospitalized in intensive care; for the optimal cut-off level, there was an adequate power of discrimination.