Dr. Cristina Mazas, Dr. Irma Domínguez and Dr. Iñaki Pascual, researchers at the European University of the Atlantic (UNEATLANTICO), are participating in a study that tests the validity and efficacy of scoring systems in predicting mortality risk in patients with COVID-19.
The COVID-19 pandemic has transformed the way health systems address mortality risk in infected patients. In this context, accurate identification of those at highest risk becomes crucial to optimize clinical management and levels of care.
Since the onset of the pandemic, various scoring systems have been used to assess mortality risk in patients with COVID-19. Some of them are the National Early Warning Score (NEWS), the Modified Early Warning Score (MEWS), the Sequential Organ Failure Assessment (SOFA), among others. However, with the appearance of new variants and treatments, specific systems have emerged, such as the COVID-19 SEIMC score (SEIMC) and the 4C mortality score (4C), designed to capture the particularities of the disease. The latter is the most widely used worldwide, demonstrating its validity as a tool for detecting patients most likely to have a poor outcome and as a useful tool for selecting the most efficient level of medical care or for guiding decisions on specific treatments.
However, COVID 19 has evolved in several aspects, mainly due to new variants that have emerged, such as Omicron, a variant that predominates in Spain in the sixth wave, with a behavior and pathogenicity different from those of the original variants. Likewise, mass vaccination has had a direct influence on the reduction of lethality, and treatments such as antivirals and monoclonal antibodies have had different effects in improving outcomes. This may have influenced the behavior of the scoring systems; therefore, it is essential to determine their validity and accuracy under current circumstances. Therefore, a study was conducted to assess the value and efficacy of two of the most commonly used scoring systems and to compare the results with validation studies conducted at the beginning of the pandemic.
The study used a retrospective and longitudinal approach, reviewing the medical records of patients with COVID-19 who were admitted to the emergency department of a Spanish medical center. The predictive ability of the 4C and SEIM scoring systems to predict 30-day mortality during the current time of the pandemic was evaluated.
The results of the study showed that both scoring systems demonstrated a high predictive ability for 30-day mortality with an accuracy of 95% and 97% for 4C and SEIMC, respectively. These results were significantly improved compared to those obtained in previous studies and support the continued utility of these scoring systems in risk assessment in patients with COVID-19. The 4c, in particular, proved to be a flexible tool, not only for assessing risk, but also for guiding decisions on the level of care needed for each patient. On the other hand, the SEIMC system showed a good correlation in the Spanish context, although its use could be more limited outside Spain.
Likewise, a decrease in the risk of high or very high mortality was observed in comparison with the data from the original studies. The high mortality risk decreased from 70.8% for 4C and 65.6% for SEIMC to 23.5% and 26.6%, respectively. This was reflected in a significant reduction in the 30-day mortality rate. Overall, however, the inpatient mortality rate remains high, and further evaluation and adjustment of these tools is needed. In addition, further research is needed to validate these results and improve the care and management of patients with COVID-19.
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