Predictive Value of Rapid Scoring Systems and Laboratory Markers in Mortality in Critically ILL Patients with COVID-19: A Prospective Cross-Sectional Study

Abstract

Background: Coronavirus Disease of 2019 (COVID-19) is a global epidemic with thousands of deaths.
Objective: This work aimed to compare the prognostic value of rapid scoring systems; the Modified Early Warning Score (MEWS) and  Rapid Emergency Medicine Score (REMS) with laboratory markers for mortality in critically ill patients with COVID-19 presenting to the ED.
Patients and Methods: This prospective cross-sectional study included a total of 92 patients with confirmed COVID19, attending the Department of Emergency Medicine, Suez Canal University Hospital, during the period from April 1, 2022, to Oct 1, 2022.
Results: D-Dimer was with sensitivity (88%) and specificity (79%) at admission and sensitivity (96%) and specificity (86%) at follow-up; C- reactive protein (CRP) was with sensitivity (96%) and specificity (59%) at follow-up; ferritin was with sensitivity (87%) and specificity (56%)  at admission and sensitivity (88%) and specificity (64%) at follow-up; IL-6 was with sensitivity (67%) and specificity (60%) at admission and  sensitivity (96%) and specificity (87%) at follow-up; Lactate dehydrogenase(LDH) was with sensitivity (96%) and specificity (60%) at follow- up; and procalcitonin (PCT) was with sensitivity (80%) and specificity (56%) at follow-up. There was a significant difference between both  groups regarding the median of MEWS (4 vs. 3, p = 0.004) and REMS (9 vs. 6, p<0.001) that were higher in non-survivors than survivors.  Conclusion: REMS was better than the MEWS score in predicting mortality. Also, D-dimer at admission and followup, CRP at follow-up,  ferritin at admission and follow-up, IL-6 at admission and follow-up, LDH at follow-up, and PCT at follow-up could be used for the  prediction of mortality better than rapid scoring systems.