Sepsis scores perform poorly in COVID-19 patients, study finds
In the latest COVID-19 news, a retrospective analysis tested common inpatient risk scores using data from patients who presented to EDs early in the pandemic, and the FDA authorized additional boosters for older and immunocompromised patients.
Commonly used risk scores did not accurately predict outcomes in patients presenting to the ED with COVID-19, a recent study found.
The retrospective study included 90,376 patients (mean age, 64.3 years; 46.8% female) who presented with COVID-19 to any of 156 EDs in the U.S. from March 2, 2020, to Feb. 11, 2021. Researchers used data from electronic health records to calculate patients' scores on the Quick Sequential Organ Failure Assessment (qSOFA), Shock Index, National Early Warning System-2 (NEWS2), and quick COVID-19 Severity Index (qCSI). Results were published by the Journal of Hospital Medicine on April 14.
In all, 17.2% of the patients died in the hospital, 28.6% were admitted to the ICU, 13.7% received mechanical ventilation, and 13.6% received vasopressors. At ED triage, only 3.8% scored a 2 or above on the qSOFA, while 45.1% had a score greater than 0.7 on the Shock Index, 49.8% had at least a 5 on the NEWS2, and 37.6% had a score of 4 or greater on the qCSI. The NEWS2 score had the highest area under the receiver-operating characteristic curve for in-hospital mortality (0.593), ICU admission (0.602), mechanical ventilation (0.614), and vasopressor receipt (0.600), but the study authors concluded that none of the scores performed well.
They called for development of new severity scores that work better for prognosis in COVID-19, and noted that better score performance might be achieved by “increasing completeness of key data, modification of models to gather data over a longer time period, novel metrics, or some combination of these.”
In other COVID-19 news, additional boosters were recently authorized for high-risk patients. On April 18, the FDA amended the emergency use authorizations of the Moderna and Pfizer-BioNTech COVID-19 vaccines to allow anyone 65 years of age or older to receive an additional dose of a bivalent vaccine at least four months following their initial bivalent dose. Most immunocompromised patients may receive an additional bivalent dose two months after the first, “and additional doses may be administered at the discretion of, and at intervals determined by, their healthcare provider,” the FDA said. The CDC revised its guidance accordingly, including no longer recommending the monovalent (original) mRNA COVID-19 vaccines for any population.
