Do we have a precise severity scoring system for predicting the prognosis of COVID-19?

Which severity scoring system is better?

Abstract

Background: The COVID-19 pandemic, caused by SARS-CoV-2, has posed unprecedented challenges to healthcare systems worldwide. Effective risk stratification tools are essential for clinical decision-making and resource allocation. This study aimed to evaluate and compare the performance of three clinical severity scoring systems: PRIEST COVID-19 Clinical Severity Score, 4C Mortality Score for COVID-19, and Pneumonia Severity Index (PSI) in predicting mortality and disease severity in patients presenting to the emergency department with COVID-19.

Materials and Methods: A prospective, single-center study was conducted at a tertiary-level Training and Research Hospital in Izmir, Turkey, between December 2020 and December 2021. Patients with clinical symptoms and confirmed COVID-19 diagnosis were included. Demographic, clinical, and laboratory data were collected. The three scoring systems were calculated, and their predictive abilities for mortality, PCR positivity, and patient care needs were assessed using statistical analyses, including ROC curve analysis.

Results: None of the scoring systems demonstrated significant predictive power for PCR positivity. However, both the 4C Mortality Score and PSI showed robust and statistically significant predictive performance for mortality, with AUCs exceeding 80%. These systems could effectively differentiate patients' care needs, with the 4C score particularly useful for ward admission decisions (AUC >9.5). In patients not requiring oxygen support, all three scoring systems exhibited statistically significant results, aiding in early identification of patients less likely to deteriorate.