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

Which severity scoring system is better?


  • Ahmet Kayalı Izmir Katip Çelebi University Faculty of Medicine Department of Emergency Medicine



PRIEST COVID-19, 4C Mortality Score for COVID-19, Pneumonia Severity Index, Mortality


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.


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Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020;395(10239):1763–1770.

Liang W, Liang H, Ou L, for the China Medical Treatment Expert Group for COVID-19, et al. Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19. JAMA Intern Med. 2020;180(8):1081.

Meyerowitz, E.A.; Richterman, A.; Gandhi, R.T.; Sax, P.E. Transmission of SARS-CoV-2: A Review of Viral, Host, and Environmental Factors. Ann. Intern. Med. 2021, 174, 69–79.

Fernandes Q, Inchakalody VP, Merhi M, et al. Emerging COVID-19 variants and their impact on SARS-CoV-2 diagnosis, therapeutics and vaccines. Ann Med. 2022;54(1):524-540.

Ochani R, Asad A, Yasmin F, et al. COVID-19 pandemic: from origins to outcomes. A comprehensive review of viral pathogenesis, clinical manifestations, diagnostic evaluation, and management. Infez Med. 2021;29(1):20-36.

Araf Y, Akter F, Tang YD, et al. Omicron variant of SARS-CoV-2: Genomics, transmissibility, and responses to current COVID-19 vaccines. J Med Virol. 2022;94(5):1825-1832.

Paraskevas T, Michailides C, Karalis I, et al. External validation of the 4C Mortality Score and PRIEST COVID-19 Clinical Severity Score in patients hospitalized with COVID-19 pneumonia in Greece. Rom J Intern Med. 2022;60(4):244-249. Published 2022 Nov 23.

Long B, Carius BM, Chavez S, et al. Clinical update on COVID-19 for the emergency clinician: Presentation and evaluation. Am J Emerg Med. 2022;54:46-57

Fan G, Tu C, Zhou F, et al. Comparison of severity scores for COVID-19 patients with pneumonia: a retrospective study. Eur Respir J. 2020;56(3):2002113.

Sheerin T, Dwivedi P, Hussain A, Sivayoham N. Performance of the CURB65, NEWS2, qSOFA, SOFA, REDS, ISARIC 4C, PRIEST and the Novel COVID-19 Severity Scores, Used to Risk-Stratify Emergency Department Patients with COVID-19, on Mortality—An Observational Cohort Study. COVID. 2023; 3(4):555-566

Li D, Zhang J, Li J. Primer design for quantitative real-time PCR for the emerging Coronavirus SARS-CoV-2. Theranostics. 2020;10(16):7150-7162.

Knight, S.R.; Ho, A.; Pius, R.; Buchan, I.; Carson, G.; Drake, T.M.; Dunning, J.; Fairfield, C.J.; Gamble, C.; Green, C.A.; et al. Risk Stratification of Patients Admitted to Hospital with COVID-19 Using the ISARIC WHO Clinical Characterisation Protocol: Development and Validation of the 4C Mortality Score. BMJ 2020, 370, m3339.

Jones A, Pitre T, Junek M, et al. External validation of the 4C mortality score among COVID-19 patients admitted to hospital in Ontario, Canada: a retrospective study. Sci Rep. 2021;11(1):18638.

Schmetzer C, Vogt E, Stellar L, et al. Self-collection of capillary blood and saliva to determine COVID-19 vaccine immunogenicity in patients with immune-mediated inflammatory diseases and health professionals. Front Public Health. 2022;10:994770.

Farrell TW, Francis L, Brown T, et al. Rationing Limited Healthcare Resources in the COVID-19 Era and Beyond: Ethical Considerations Regarding Older Adults. J Am Geriatr Soc. 2020;68(6):1143-1149.

Naderi HR, Sheybani F, Sarvghad M, Nooghabi MJ. Can Procalcitonin Add to the Prognostic Power of the Severity Scoring System in Adults with Pneumonia? Tanaffos. 2015;14(2):95-106.

Heydari F, Zamani M, Masoumi B, et al. Physiologic Scoring Systems in Predicting the COVID-19 Patients' One-month Mortality; a Prognostic Accuracy Study. Arch Acad Emerg Med. 2022;10(1):e83.




How to Cite

Kayalı, A. (2023). Do we have a precise severity scoring system for predicting the prognosis of COVID-19? Which severity scoring system is better?. Chronicles of Precision Medical Researchers, 4(3), 440–446.

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