Department of Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran.
Can Respir J. 2022 Mar 28;2022:5129314. doi: 10.1155/2022/5129314. eCollection 2022.
COVID-19 pandemic has become a global dilemma since December 2019. Are the standard scores, such as acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) score, accurate for predicting the mortality rate of COVID-19 or the need for new scores? We aimed to evaluate the mortality predictive value of APACHE II and SOFA scores in critically ill COVID-19 patients.
In a cohort study, we enrolled 204 confirmed COVID-19 patients admitted to the intensive care units at the Imam Khomeini hospital complex. APACHE II on the first day and daily SOFA scoring were performed. The primary outcome was the mortality rate in the nonsurvived and survived groups, and the secondary outcome was organ dysfunction. Two groups of survived and nonsurvived patients were compared by the chi-square test for categorical variables and an independent sample -test for continuous variables. We used logistic regression models to estimate the mortality risk of high APACHE II and SOFA scores.
Among 204 severe COVID-19 patients, 114 patients (55.9%) expired and 169 patients (82.8%) had at least one comorbidity that 103 (60.9%) of them did not survive (=0.002). Invasive mechanical ventilation and its duration were significantly different between survived and nonsurvived groups ( ≤ 0.001 and =0.002, respectively). Mean APACHE II and mean SOFA scores were significantly higher in the nonsurvived than in the survived group (14.4 ± 5.7 vs. 9.5 ± 5.1, ≤ 0.001, 7.3 ± 3.1 vs. 3.1 ± 1.1, ≤ 0.001, respectively). The area under the curve was 89.5% for SOFA and 73% for the APACHE II score. Respiratory diseases and malignancy were risk factors for the mortality rate (=0.004 and =0.007, respectively) against diabetes and hypertension.
The daily SOFA was a better mortality predictor than the APACHE II in critically ill COVID-19 patients. But they could not predict death with high accuracy. We need new scoring with consideration of the prognostic factors and daily evaluation of changes in clinical conditions.
自 2019 年 12 月以来，COVID-19 大流行已成为全球性难题。标准评分，如急性生理学和慢性健康评估（APACHE II）和序贯器官衰竭评估（SOFA）评分，是否能准确预测 COVID-19 的死亡率或需要新的评分？我们旨在评估 APACHE II 和 SOFA 评分在危重症 COVID-19 患者中的死亡率预测价值。
在一项队列研究中，我们纳入了 204 名入住伊玛目霍梅尼医院综合大楼重症监护病房的确诊 COVID-19 患者。在入院的第一天和之后的每天对患者进行 APACHE II 和 SOFA 评分。主要结局为未存活组和存活组的死亡率，次要结局为器官功能障碍。采用卡方检验比较两组间分类变量，独立样本 t 检验比较两组间连续变量。采用 logistic 回归模型估计高 APACHE II 和 SOFA 评分的死亡风险。
在 204 例严重 COVID-19 患者中，114 例（55.9%）患者死亡，169 例（82.8%）患者存在至少一种合并症，其中 103 例（60.9%）患者死亡（=0.002）。有创机械通气及其持续时间在存活组和未存活组间有显著差异（分别为≤0.001 和=0.002）。未存活组的平均 APACHE II 和 SOFA 评分明显高于存活组（14.4±5.7 vs. 9.5±5.1，≤0.001；7.3±3.1 vs. 3.1±1.1，≤0.001）。SOFA 评分的曲线下面积为 89.5%，APACHE II 评分的曲线下面积为 73%。呼吸疾病和恶性肿瘤是死亡率的危险因素（=0.004 和=0.007），而糖尿病和高血压则不是。
在危重症 COVID-19 患者中，每日 SOFA 是比 APACHE II 更好的死亡率预测指标。但它们不能准确预测死亡率。我们需要考虑预后因素和临床状况的每日变化，制定新的评分。
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