Development of a severity assessment score for COVID-19: COVID Severity Score (CSS) at the time of admission to hospital

Abstract

BackgroundAs of mid-2022, more than 650 million people have been infected with COVID-19 worldwide. With ongoing outbreaks and varying degrees of severity in different regions of the globe, we continue to battle against this global health crisis after 3 years of the discovery of Sars-CoV-2. It is crucial for clinicians to utilize the information collected over this time period to combat any upcoming wave in the future. One approach to this is the development of a scoring system that can assess the severity of COVID-19 patients at the time of admission. Although much is known about the course of its clinical disease, much more is yet to be discovered in terms of its optimal management to yield favorable outcomes. Recognizing key risk factors and biochemical parameters can assist in an early assessment of the severity of COVID-19, thus leading to timely management and reducing morbidity and mortality.ObjectiveOur team created a scoring system called COVID-19 Severity Score (CSS), to assess the severity of COVID-19 upon admission. The primary objective of CSS is to identify patients who are at a higher risk of experiencing negative outcomes such as admission to ICU, increased need for oxygen, requirement of mechanical ventilation, and in-hospital mortality.MethodsA retrospective study was carried out on 102 at a tertiary care hospital, Dr. Ziauddin University Hospital (North Campus), Karachi. Patients tested positive for SARS-CoV-2 through reverse transcription polymerase chain reaction (RT-PCR) or rapid antigen detection tests. Electronic medical records (EMR) and chart reviews were used to gather data, which was analyzed using SPSS v.26.0.ResultsThe COVID-19 Severity Score (CSS) is a cumulative score of 9 parameters, established after monitoring 102 COVID-19 patients. Each parameter is assigned a score based on cut-off ranges, including a semi-quantitative method for evaluating chest X-rays. The total score for each patient is obtained by adding individual scores, with a maximum score of 29. The grading system for determining the "risk of severity" is divided into four groups, and the study evaluated the effectiveness of CSS in determining the risk of severe COVID-19 based on four parameters: length of hospital stay, need for mechanical ventilation, amount of oxygen administered, and mortality outcome at discharge. Overall, the study highlights the importance of identifying high-risk patients and providing timely interventions to improve outcomes in severe COVID-19 cases. The study found that patients belonging to the CSS group above 20 exhibited a notable rise in the need for mechanical ventilation, and 13.7% of patients required mechanical ventilation to maintain adequate pulmonary function out of those 71.42% of the patients had a CSS score of more than 20.Patients with higher CSS scores also had higher oxygen requirements, with 73.33% of patients requiring 50-60 L of oxygen belonging to the CSS group above 20. Mortality rates were also highest among patients with CSS scores above 20, accounting for 76.47% of total deaths.ConclusionWhile further research is needed to fully validate these scoring systems, they hold promise as a valuable tool for healthcare professionals during the COVID-19 pandemic. It is our belief that the CSS can be an asset to hospitals during such decision-making moments. Keywords: Severity Assessment Score; COVID-19: COVID Severity Score; CSS; Karachi