The Clinical Implementation of NEWS, SOFA, and CALL Scores in Predicting the In-Hospital Outcome of Severe or Critical COVID-19 Patients

OBJECTIVE: To date, there is no specific validated coronavirus disease 2019 score to assess the disease severity. This study aimed to evaluate the performance of the National Early Warning Score, Sequential Organ Failure Assessment, and Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase scores in predicting the in-hospital outcome of critical or severe coronavirus disease 2019 patients. MATERIALS AND METHODS: Single-centered analytical study was carried out in the coronavirus disease 2019 high dependency unit from April to August 2020. National Early Warning Score, Sequential Organ Failure Assessment, and Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase scores were calculated for each critical to severely ill coronavirus disease 2019 patient. The diagnostic accuracy of these 3 scores in determining the in-hospital outcome of coronavirus disease 2019 patients was assessed by area under the receiver operating characteristic curve. The cut-off value of each score along with sensitivity, specificity, and positive and negative likelihood ratio were calculated by Youden index. Predictors of outcome in coronavirus disease 2019 patients were analyzed by Cox-regression analysis. RESULTS: The area under the curve was highest for the Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase score (area under the curve = 0.85) while the Sequential Organ Failure Assessment score had an area under the curve of 0.72. The cut-off values for National Early Warning Score score was 8 (sensitivity = 72.34%, specificity = 76.10%), Sequential Organ Failure Assessment score was 3 (sensitivity = 68.97%, specificity = 67.42%), and Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase score was 8 (sensitivity = 88.89%, specificity = 66.67%). The pairwise comparison showed that the difference between the area under the curve of these 3 scores was statistically insignificant (P > .05). The rate of mortality and invasive ventilation was significantly high in groups with high National Early Warning Score, Sequential Organ Failure Assessment, and Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase scores (P < .0001). These 3 scores, age, low platelets, and high troponin-T levels were found to be statistically significant predictors of outcome CONCLUSION: Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase score had a good area under the curve, the highest sensitivity of its cut-off value, required only 4 parameters, and is easy to calculate so it may be a better tool among the 3 scores in outcome prediction for coronavirus disease 2019 patients.