Novel score predicts early mortality risk in intubated COVID-19 patients

A novel predictive score shows acceptable accuracy for predicting early mortality in intubated patients with the coronavirus disease 2019 (COVID-19), reports a recent study.

To first develop the predictive score, the researchers applied a logistic regression model to a retrospective dataset of 1,389 intubated COVID-19 patients (median age 65 years, 69.4 percent men) admitted to 12 New York City hospitals. External validation was conducted in a sample consisting of 556 patients (median age 67 years, 65.8 percent men).

The 14-day mortality rates in the derivation and validation cohorts were 43.8 percent and 48.0 percent, respectively. Analysis of the derivation cohort identified seven key predictive variables: age, prior history of chronic kidney disease (CKD), mean arterial pressure (MAP) and vasopressor need, oxygen index, and blood urea nitrogen (BUN), ferritin, and pH.

Combining all above factors yielded the Intubated COVID-19 Predictive score (ICOP), which provides values from 0–100 percent, indicative of lowest to highest early death risk after intubation, respectively.

ICOP yielded a c-statistic of 0.75 (95 percent confidence interval [CI], 0.73–0.78) in the derivation, 0.72 (95 percent CI, 0.68–0.76) in the internal validation, and 0.71 (95 percent CI, 0.67–0.57) in the external validation cohorts.

Moreover, ICOP performed significantly better at predicting early mortality than the established scores such as the sequential organ failure assessment and CURB-65* in both the derivation and validation cohorts.

“The areas under the curve of these scores in external validation were greater than 0.7, which is regarded as an acceptable predictive accuracy,” the researchers said.

“In actual clinical practice, we believe that risk stratification based on the ICOP score is mainly helpful for guiding joint decision-making among patients’ family and medical staff in regard to future treatment options, distinguishing patients who can benefit from the valuable and limited medical resources, and determining when to advance intubated patients onto extracorporeal membrane oxygenation,” they added.

*Confusion, uraemia, respiratory rate, blood pressure, age >65 years