Comparison of Various Clinical Scoring Systems in Predicting Progression and Outcome in COVID 19 Infection

Aim: Comparison of various scoring systems and to find the better one for predicting the progression of disease in COVID-19 infection.

Study Design: Observational.

Place and Duration: Department of General medicine, Dhiraj hospital, a tertiary care center, located in Gujarat, India over period of 4 month (May-august 2020).

Methodology: We included consecutive 300 adult patients of Asian ethnicity with COVID 19 infection, admitted in the hospital in ICU and Ward, who signed for participation. Various clinical scoring systems evaluated and compared for predictability of progression in COVID-19 infection which included two well-established and widely used systems- CURB-65 and qSOFA and two recent models, one being novel scoring model- CALL score used exclusively for COVID19 patients and other, the modified version of NEWS2 system. These scores were calculated for each confirmed COVID-19 positive patient on admission. WHO clinical disease severity grading was used to stratify patients and as reference for comparison with other scores.

Results: Of the 300 patients, 197(65.6%) were male and 103(34.3%) were female with mean age of 49.74±15.69 years. 95(31.6%) patients had co-morbidities, hypertension being the most common (21%) followed by diabetes (14.3%). Using WHO clinical disease severity, 160 (53.3%) patients had mild disease, 68(22.6%) had moderate and 72(24%) had severe disease. The four scoring systems were applied and compared for predictability. NEWS2 system had higher discriminative power(AUC,0.69; 95%CI, 45.5 -72.9%) followed by qSOFA (AUC,0.41; 95%CI, 35.3-48.2%), CALL score had lower discrimination (AUC,0.40; 95%CI, 33.5-46.9%) and CURB-65 had the poor values (AUC,0.35; 95%CI, 29.3-42.1%) in predicting the progression of disease in admitted patients. NEWS2 had sensitivity and specificity of 69.7% and 100% respectively.

Conclusion: In this study, four clinical scoring systems were compared on admission and NEWS2 system of risk stratification was found more accurate and better in predicting the disease progression in COVID19 positive patients.