Evaluation of MULBSTA, SOFA, APACHE II scores and hematological parameters as predictors of mortality in COVID-19 pneumonia
Abstract
Aim: COVID-19 (coronavirus disease 2019) pneumonia is a serious condition with high mortality and morbidity. Tools are needed for effective diagnosis and better prediction of prognosis in the course of this disease. This study aimed to compare the effectiveness of the MuLBSTA (Multilobular infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension and Age) score with blood parameters, SOFA (Sequential Organ Failure Assessment), and APACHE II (Acute Physiology and Chronic Health Evaluation II) scores, and to investigate its significance in predicting 28-day mortality in patients diagnosed with COVID-19 and followed up in the intensive care unit (ICU).
Material and Method: This study included 312 patients admitted to ICU for COVID-19 infection. SOFA, MuLBSTA and APACHE-II scores of patients were estimated at ICU admission. Demographic data and laboratory results of patients were retrospectively reviewed.
Results: Of the 312 patients included in the study, 58.7% (n=183) were male and 41.3% (n=129) were female. The AUC value was 0.863 for the SOFA score and 0.843 for the MuLBSTA score. The MuLBSTA score was positively correlated with the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), while it was negatively correlated with the lymphocyte-to-monocyte ratio (LMR). Patients were divided into two groups as high-risk and low-risk, considering a cut-off value of 12 for the MuLBTSA score. The survival time of patients with a high-risk MuLBTSA score was 12±0.78 days, while the survival time of patients with a low MuLBTSA score was 22.8±1.3 days.
Conclusion: The combined use of the MuLSBTA score, SOFA score, and NLR after ICU admission for COVID-19 pneumonia will be more effective in predicting mortality.
Supporting Institution
None
References
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- Steinberg E, Balakrishna A, Habboushe J, Shawl A, Lee J. Calculated decisions: COVID-19 calculators during extreme resource-limited situations. Emerg Med Pract 2020; 22: CD1-CD5.
- Godinjak A, Iglica A, Rama A, et al. Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit. Acta Med Acad 2016; 45: 97-103.
- Lambden S, Laterre PF, Levy MM, Francois B. The SOFA score-development, utility and challenges of accurate assessment in clinical trials. Crit Care 2019; 23: 374.
- Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol 2020; 84: 106504.
- Kartal O, Kartal AT. Value of neutrophil to lymphocyte and platelet to lymphocyte ratios in pneumonia. Bratisl Lek Listy 2017; 118: 513-6.
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- Citu C, Gorun F, Motoc A, et al. The predictive role of NLR, d-NLR, MLR, and SIRI in COVID-19 mortality. Diagnostics (Basel) 2022; 12: 122.
- Curbelo J, Rajas O, Arnalich B, et al. Neutrophil count percentage and neutrophil-lymphocyte ratio as prognostic markers in patients hospitalized for community-acquired pneumonia. ArchBronconeumol 2019; 55: 472-7.
- Fayed M, Patel N, Angappan S, et al. Sequential organ failure assessment (SOFA) score and mortality prediction in patients with severe respiratory distress secondary to COVID-19. Cureus 2022; 14: e26911.
- Gowda N, Domınah G, Rogers H, et al. Evaluating Apache and Sofa scoring systems in patients with COVID-19. Chest 2021;160: A1077.
- García Clemente MM, Herrero Huertas J, Fernández Fernández A, et al. Assessment of risk scores in Covid-19. Int J Clin Pract 2021; 75: e13705.
- Peng J, Qi D, Yuan G, et al. Diagnostic value of peripheral hematologic markers for coronavirus disease 2019 (COVID-19): A multicenter, cross-sectional study. J Clin Lab Anal 2020; 34: e23475.
- Xu R, Hou K, Zhang K, et al. Performance of two risk-stratification models in hospitalized patients with coronavirus disease. Front Med (Lausanne) 2020; 7: 518.
Abstract
References
- Baloch S, Baloch MA, Zheng T, Pei X. The Coronavirus disease 2019 (COVID-19) pandemic. Tohoku J Exp Med 2020; 250: 271-8.
- Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; 382: 1199-207.
- World Health Organization [Internet]. Statement on the first meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Available from: https://who.int/news/item/23-01-2020-statement-on-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)
- Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507-13
- Ragab D, Salah Eldin H, Taeimah M, Khattab R, Salem R. The COVID-19 cytokine storm; what we know so far. Front Immunol 2020; 11: 1446.
- Msemburi W, Karlinsky A, Knutson V, Aleshin-Guendel S, Chatterji S, Wakefield J. The WHO estimates of excess mortality associated with the COVID-19 pandemic. Nature 2023; 613: 130-7.
- Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China [published correction appears in JAMA Intern Med 2020; 180: 934-43.
- Guo L, Wei D, Zhang X, et al. Clinical features predicting mortality risk in patients with viral pneumonia: The MuLBSTA score. Front Microbiol 2019; 10: 2752.
- Steinberg E, Balakrishna A, Habboushe J, Shawl A, Lee J. Calculated decisions: COVID-19 calculators during extreme resource-limited situations. Emerg Med Pract 2020; 22: CD1-CD5.
- Godinjak A, Iglica A, Rama A, et al. Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit. Acta Med Acad 2016; 45: 97-103.
- Lambden S, Laterre PF, Levy MM, Francois B. The SOFA score-development, utility and challenges of accurate assessment in clinical trials. Crit Care 2019; 23: 374.
- Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol 2020; 84: 106504.
- Kartal O, Kartal AT. Value of neutrophil to lymphocyte and platelet to lymphocyte ratios in pneumonia. Bratisl Lek Listy 2017; 118: 513-6.
- Merekoulias G, Alexopoulos EC, Belezos T, Panagiotopoulou E, Jelastopulu DM. Lymphocyte to monocyte ratio as a screening tool for influenza. PLoS Curr 2010; 2: RRN1154.
- Qu R, Ling Y, Zhang YH, et al. Platelet-to-lymphocyte ratio is associated with prognosis in patients with coronavirus disease-19. J Med Virol 2020; 92: 1533-41.
- Koç A. Can PCO2 be a mortality predictor in COVID-19 patients?. J Med Palliat Care 2022; 3: 268-274.
- Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323: 1239-42.
- Preetam M, Anurag A. MuLBSTA score in COVID-19 pneumonia and prediction of 14-day mortality risk: A study in an Indian cohort. J Family Med Prim Care 2021; 10: 223-7.
- Kang SJ, Jung SI. Age-related morbidity and mortality among patients with COVID-19. Infect Chemother 2020; 52: 154-64.
- Leung C. Risk factors for predicting mortality in elderly patients with COVID-19: a review of clinical data in China. Mech Ageing Dev 2020; 188: 111255.
- Cellina M, Gibelli D, Valenti Pittino C, Toluian T, Marino P, Oliva G. Risk factors of fatal outcome in patients with COVID-19 pneumonia. Disaster Med Public Health Prep 2022; 16: 271-8.
- Zhang L, Hou J, Ma FZ, Li J, Xue S, Xu ZG. The common risk factors for progression and mortality in COVID-19 patients: a meta-analysis. Arch Virol 2021; 166: 2071-87.
- Beigmohammadi MT, Amoozadeh L, Rezaei Motlagh F, et al. Mortality Predictive Value of APACHE II and SOFA Scores in COVID-19 Patients in the Intensive Care Unit. Can Respir J 2022; 2022: 5129314.
- Wang J, Zhang F, Jiang F, Hu L, Chen J, Wang Y. Distribution and reference interval establishment of neutral-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in Chinese healthy adults. J Clin Lab Anal 2021; 35: e23935.
- Citu C, Gorun F, Motoc A, et al. The predictive role of NLR, d-NLR, MLR, and SIRI in COVID-19 mortality. Diagnostics (Basel) 2022; 12: 122.
- Curbelo J, Rajas O, Arnalich B, et al. Neutrophil count percentage and neutrophil-lymphocyte ratio as prognostic markers in patients hospitalized for community-acquired pneumonia. ArchBronconeumol 2019; 55: 472-7.
- Fayed M, Patel N, Angappan S, et al. Sequential organ failure assessment (SOFA) score and mortality prediction in patients with severe respiratory distress secondary to COVID-19. Cureus 2022; 14: e26911.
- Gowda N, Domınah G, Rogers H, et al. Evaluating Apache and Sofa scoring systems in patients with COVID-19. Chest 2021;160: A1077.
- García Clemente MM, Herrero Huertas J, Fernández Fernández A, et al. Assessment of risk scores in Covid-19. Int J Clin Pract 2021; 75: e13705.
- Peng J, Qi D, Yuan G, et al. Diagnostic value of peripheral hematologic markers for coronavirus disease 2019 (COVID-19): A multicenter, cross-sectional study. J Clin Lab Anal 2020; 34: e23475.
- Xu R, Hou K, Zhang K, et al. Performance of two risk-stratification models in hospitalized patients with coronavirus disease. Front Med (Lausanne) 2020; 7: 518.
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