SAPS 3 as a 28-day mortality predictor in critically ill COVID-19 patients

Abstract

Background: The case fatality rate (CFR) of COVID-19 was 8.7% in Indonesia on April 2020. Simplified Acute Physiology Score 3 (SAPS 3) has been used to predict the hospital mortality based on different variables including acute physiologic derangements, current conditions and interventions, and previous health status assess the severity of condition during the first hour of admission to the ICU. We assessed SAPS 3 to predict the outcome and mortality of critical COVID-19 patients in ICU over a period of 28 days. Methodology: This retrospective cohort study consisted of adult patients admitted to ICU with probable or confirmed COVID-19 in our hospital. We recorded the patients SAPS 3 score from the medical record as well as the 28-day mortality. Validity of the SAPS 3 score was done by the Area Under Curve (AUC) measurement and Hosmer-Lemeshow calibration test. Results: The mortality rate of critical COVID-19 patients was 43.8%. The age, intra-hospital location before ICU admission, use of vasoactive drugs (P < 0.0001), focal neurological deficits (P < 0.0001), respiratory failure (P = 0.004), creatinine ≥ 3.5 mg/dL (P = 0.005), and platelets < 50,000 /µL (P = 0.032) were significantly associated with 28-days mortality in the ICU. SAPS 3 showed good discrimination and predictability. The optimal cut-off point was 39 with 70.3% sensitivity and 74.4% specificity. Conclusion: SAPS3 score system was valid in predicting the 28-day mortality of COVID-19 patients in the ICU with good discrimination and calibration value; therefore, it is an important predictor tool for early prognosis screening that will help reduce the strain over the ICU resources. Abbreviations: CFR: Case Fatality Rate; SAPS 3: Simplified Acute Physiology Score 3; COVID-19: The Coronavirus Disease 2019; ICU: Intensive Care Unit; APACHE: Acute Physiology and Chronic Health Evaluation; SPSS: Statistical Package for Social Sciences; GCS: Glasgow Coma Scale; ROC: Receiver Operating Characteristic; PHEIC: Public Health Emergency of International Concern; OR: Odds Ratio