Evaluation of four novel prognostic scores on admission for COVID-19 mortality. An experience from a Mediterranean tertiary center

Biruni Index as a Novel Diagnostic Tool for the Early Prediction of Mortality in Critical Patients With COVID-19: A Cohort Study

BACKGROUND

The aim of this study was to find out the potential risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19) patients hospitalized due to viral bronchopneumonia, and to establish a novel COVID-19 mortality index for daily use.

METHODS

The study included 431 quantitative real-time polymerase chain reaction (qRT-PCR)-confirmed COVID-19-positive patients admitted to the intensive care unit in a tertiary care hospital. Patients were divided into training and validation cohorts at random (n= 285 and n= 130, respectively). Biruni Index was developed by multivariate logistic regression analysis for predicting COVID-19-related mortality.

RESULTS

In univariate logistic regression analysis, age, systolic and diastolic blood pressures, respiratory and pulse rates per minute, D-dimer, pH, urea, ferritin, and lactate dehydrogenase levels at first admission were statistically significant factors for the prediction of mortality in the training cohort. By using multivariate logistic regression analysis, all of these statistically significant parameters were used to produce Biruni Index. Statistically significant differences in Biruni Index were observed between ex and non-ex groups in both training and validation cohorts (P < 0.001 for both comparisons). Areas under receiver operating characteristic (ROC) curve for Biruni Index were 0.901 (95CI%: 0.864-0.938, P < 0.001) and 0.860 (95CI%: 0.795-0.926, P < 0.001) in training and validation cohorts, respectively.

CONCLUSION

As a pioneering clinical study, Biruni Index may be a useful diagnostic tool for clinicians to predict the mortality in critically ill patients with COVID-19 hospitalized due to severe viral bronchopneumonia. However, Biruni Index should be validated with larger series of multicenter prospective clinical studies.

COVID-19'da hastane içi mortaliteyi tahmin etmede enflamatuvar temelli parametrelerin ve MELD-XI skorunun 4C mortalite skoru ile karşılaştırılması

Purpose: In this study, we compared the roles of inflammatory parameters such as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), C-reactive protein/lymphocyte ratio (CLR), monocyte/lymphocyte ratio (MLR), neutrophil/platelet ratio (NPR), neutrophil/monocyte ratio (NMR), CRP/albumin ratio (CAR), BUN/albumin ratio (BAR), MELD-XI score and 4C mortality score in predicting in-hospital mortality risk in COVID-19. Materials and Methods: A total of 117 patients over 18 years old with a PCR-confirmed diagnosis of COVID-19 between June 2020 and February 2021 were retrospectively included. The roles of parameters for independently predicting in-hospital mortality were determined and compared with each other using appropriate statistical methods. Results: Age, chronic kidney disease, diabetes mellitus, acute kidney injury, and length of hospital stay, urea, creatinine, LDH, AST, ferritin, D-dimer, CRP, albumin, Hb, CLR, BAR, CAR, MELD-XI score, and 4C mortality score were significantly correlated to in-hospital mortality. However, only the 4C mortality score and AST independently predicted in-hospital mortality in COVID-19 [OR 2.08 (%95 CI 1.06-2.36), for 4C mortality score, and OR 1.05 (%95 CI 1.00-1.10), for AST]. Conclusion: Unlike other mortality-related inflammatory parameters, the 4C mortality score and AST were independent and strong predictors of mortality in hospitalized COVID-19 patients.