Mortality predictive value of APACHE II Scores in COVID-19 patients in the intensive care unit: a cross-sectional study

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Introduction:

The Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system was developed to predict hospital mortality, which can be used as a predictor of final hospital outcome in coronavirus disease 2019 (COVID-19) patients. Therefore, the present study was designed and conducted with the aim of determining the average APACHE II score in patients with COVID-19 patients.

Methods:

In this cross-sectional study, patients with COVID-19 infection confirmed by PCR test were enrolled in the ICU of Imam Khomeini Hospital in Urmia city during 2020–2022. The laboratory, radiological, and clinical findings of the patients were collected and evaluated. The APACHE II scores of the patients were also calculated by the specialists of ICU and Infectious Diseases Department for each patient and recorded in the checklist.

Results:

A total of 150 patients were examined in this study. The mean age of the patients was 53.71±16.02 years; 82 patients, or 54.7%, were male, and 68 patients, or 45.3%, were female. The mean APACHE II score was 10.12±6.3; 105 patients (0.70%) were discharged, and 45 patients (0.30%) died. The mean APACHE II score was significantly higher in patients with cough ( P=0.001), shortness of breath ( P=0.002), hemoptysis ( P>0.001), gastrointestinal hemorrhage ( P=0.002), and renal failure ( P=0.001). In addition, there was a significant direct relationship between age and APACHE II score, such that APACHE II score increased significantly with age (r=0.53, P>0.001). The mean APACHE II score in men was 10.04±5.8 and in women was 10.20±6.9, and according to the results of the independent t-test, there was no statistically significant difference between the two sexes (0.88). The mean APACHE II score was lower in patients with a history of dialysis ( P=0.01), thyroid disease ( P>0.001), hypertension ( P>0.001), ischemic heart disease ( P=0.04), and diabetes ( P=0.02) were significantly higher.

Conclusion:

Patients with gastrointestinal bleeding, cough, shortness of breath, hemoptysis, and renal failure after COVID-19 infection, with a history of dialysis, thyroid disease, hypertension, and diabetes, and intubated patients had a significantly higher APACHE II score. A significant relationship was found between patients’ age and the APACHE II score. However, this index was not a suitable criterion for predicting death in COVID-19 patients.

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Most cited references 27

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Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou, Ting Yu, Ronghui Du … (2020)

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

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Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding

Roujian Lu, Xiang Zhao, Juan Li … (2021)

Summary Background In late December, 2019, patients presenting with viral pneumonia due to an unidentified microbial agent were reported in Wuhan, China. A novel coronavirus was subsequently identified as the causative pathogen, provisionally named 2019 novel coronavirus (2019-nCoV). As of Jan 26, 2020, more than 2000 cases of 2019-nCoV infection have been confirmed, most of which involved people living in or visiting Wuhan, and human-to-human transmission has been confirmed. Methods We did next-generation sequencing of samples from bronchoalveolar lavage fluid and cultured isolates from nine inpatients, eight of whom had visited the Huanan seafood market in Wuhan. Complete and partial 2019-nCoV genome sequences were obtained from these individuals. Viral contigs were connected using Sanger sequencing to obtain the full-length genomes, with the terminal regions determined by rapid amplification of cDNA ends. Phylogenetic analysis of these 2019-nCoV genomes and those of other coronaviruses was used to determine the evolutionary history of the virus and help infer its likely origin. Homology modelling was done to explore the likely receptor-binding properties of the virus. Findings The ten genome sequences of 2019-nCoV obtained from the nine patients were extremely similar, exhibiting more than 99·98% sequence identity. Notably, 2019-nCoV was closely related (with 88% identity) to two bat-derived severe acute respiratory syndrome (SARS)-like coronaviruses, bat-SL-CoVZC45 and bat-SL-CoVZXC21, collected in 2018 in Zhoushan, eastern China, but were more distant from SARS-CoV (about 79%) and MERS-CoV (about 50%). Phylogenetic analysis revealed that 2019-nCoV fell within the subgenus Sarbecovirus of the genus Betacoronavirus, with a relatively long branch length to its closest relatives bat-SL-CoVZC45 and bat-SL-CoVZXC21, and was genetically distinct from SARS-CoV. Notably, homology modelling revealed that 2019-nCoV had a similar receptor-binding domain structure to that of SARS-CoV, despite amino acid variation at some key residues. Interpretation 2019-nCoV is sufficiently divergent from SARS-CoV to be considered a new human-infecting betacoronavirus. Although our phylogenetic analysis suggests that bats might be the original host of this virus, an animal sold at the seafood market in Wuhan might represent an intermediate host facilitating the emergence of the virus in humans. Importantly, structural analysis suggests that 2019-nCoV might be able to bind to the angiotensin-converting enzyme 2 receptor in humans. The future evolution, adaptation, and spread of this virus warrant urgent investigation. Funding National Key Research and Development Program of China, National Major Project for Control and Prevention of Infectious Disease in China, Chinese Academy of Sciences, Shandong First Medical University.

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Author and article information

Contributors

Hamid Reza Mehryar

Poya Yarahmadi

Babak C. Anzali

Journal

Journal ID (nlm-ta): Ann Med Surg (Lond)

Journal ID (iso-abbrev): Ann Med Surg (Lond)

Journal ID (publisher-id): MS9

Title: Annals of Medicine and Surgery

Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )

ISSN (Electronic): 2049-0801

Publication date Collection: June 2023

Publication date (Electronic): 18 April 2023

Volume: 85

Issue: 6

Pages: 2464-2468

Affiliations

[a ]Department of Emergency Medicine

[b ]Department of Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

Author notes

[* ]Corresponding author. Address: Department of Emergency Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Medicine Faculty, Campus Nazlu, 11 KM Road Seru, Urmia, West Azerbaijan 575611-5111, IRAN. Tel: +98 914 341 5627, fax: +98 441 275 4921. E-mail: anzalibabak@ 123456yahoo.com (B. C. Anzali).

Article

Publisher ID: AMSU-D-23-00012 Accession ID: 00029

DOI: 10.1097/MS9.0000000000000641

PMC ID: 10289627

PubMed ID: 37363464

SO-VID: 0e3e32f8-f7e0-4f8e-86d4-90ee7dbd317a

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

History

Date received : 4 January 2023

Date accepted : 31 March 2023

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Keywords: apache ii score,covid-19,intensive care unit,mortality,patient

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Keywords: apache ii score, covid-19, intensive care unit, mortality, patient

Mortality predictive value of APACHE II Scores in COVID-19 patients in the intensive care unit: a cross-sectional study

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Novel Coronavirus Disease COVID-19

Most cited references 27

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding

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