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Performance of prognostic scoring systems in patients with COVID-19 interstitial pneumonia in Acute Medical Unit

Background: The early detection of COVID-19 patients with interstitial
pneumonia at high risk of dismal outcome is necessary to deliver proper
care and optimize management of limited resources. Objective: The aim of
this study was to analyse the performance of pre-existing scores in
predicting in-hospital mortality and ICU transfer at admission in an
Acute Medical Unit. Methods: 106 consecutive patients with acute
respiratory failure due to COVID-19 interstitial pneumoni admitted to
Acute Medical Unit were enrolled. The performances of NEWS, SIRS, RAPS,
REMS, qSOFA, APACHE II, CURB-65 and PSI were analysed by the Area Under
the Receiver Operator Characteristic (AUROCs) and standard indices of
accuracy. Results: Considering in-hospital mortality PSI and APACHE II
had the higher AUROCs, 0.83 (95% CI 0.75-0.91) and 0.80 (95% CI
0.71-0.88), followed by REMS, 0.77 (95% CI 0.67-0.86), and CURB-65,
0.73 (95% CI 0.63-0.82), whereas the AUROCs of the other scores were
< 0.7. PSI and APACHE II had good sensitivity (0.92 and 0.97),
negative predictive value (0.96 and 0.97) and negative likelihood ratio
(0.1 and 0.1), accurately identifying patients at low risk to die.
However, the low specificity (0.70 and 0.47) and positive likelihood
ratio (3.1 and 1.8) could limit their usefulness in predicting
in-hospital mortality. Considering ICU admissions all the scores, except
NEWS, SIRS and qSOFA, showed a worse performance. Conclusions: PSI and
APACHE II showed good prognostic results in predicting in-hospital
mortality but no pre- existing score validated for acute care settings
was totally satisfactory to predict adverse outcomes in COVID-19
interstitial pneumonia after admission to Acute Medical Unit. The
application setting and selected outcome criteria should always be
considered to evaluate and compare scoring systems’ performance
analysis.