1887
Volume 2025, Issue 2
  • EISSN: 2220-2749

Abstract

ABSTRACT

The COVID-19 pandemic has posed significant challenges to healthcare systems, underscoring the need for effective triage tools to predict disease severity and guide clinical decision-making. Several prognostic scoring systems have been developed for this purpose, yet their relative effectiveness remains unclear. This study evaluates the performance of five commonly used scoring systems – CRB65, modified PRIEST (mPRIEST), NEWS2, Modified Early Warning Score (MEWS), and Quick COVID-19 Severity Index (qCSI) – in predicting in-hospital mortality and intensive care unit (ICU) admissions among COVID-19 patients.

A retrospective prognostic accuracy study was performed involving 7,674 adult patients diagnosed with COVID-19 at Hamad General Hospital, Qatar. Data were extracted from electronic medical records, and severity scores were calculated based on patients’ initial clinical presentation. The predictive accuracy of each score for mortality and ICU admission was assessed using the area under the receiver operating characteristic curve (ROC AUC), along with sensitivity, specificity, and Youden’s index.

In the study cohort, the overall mortality rate was 1.1%, with an ICU admission rate of 5.2%. Among the various scoring systems evaluated, mPRIEST demonstrated the highest AUC for predicting mortality (0.899) and ICU admission (0.888), followed by qCSI (0.870 for mortality, 0.865 for ICU admission) and NEWS2 (0.858 and 0.866, respectively). In contrast, CRB65 and MEWS showed lower predictive accuracy, with AUC values of 0.776 and 0.672 for mortality and 0.692 and 0.670 for ICU admission, respectively.

The findings indicate that mPRIEST and qCSI are the most accurate prognostic scores among those evaluated for predicting mortality and ICU admission, thus serving as valuable tools for COVID-19 triage in emergency settings. NEWS2 also demonstrated strong predictive performance, whereas CRB65 and MEWS were comparatively less effective. These insights help optimize early risk stratification and resource allocation in clinical practice.

© 2025 The Author(s), licensee HBKU Press.
Loading

Article metrics loading...

/content/journals/10.5339/avi.2025.11
2025-08-20
2025-12-07

Metrics

Loading full text...

Full text loading...

/deliver/fulltext/avi/2025/2/avi.2025.11.html?itemId=/content/journals/10.5339/avi.2025.11&mimeType=html&fmt=ahah

References

  1. World Health Organization . WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. Geneva: WHO; 2020 [cited 2025 Mar 20]. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
     [Google Scholar]
  2. World Health Organization . COVID-19 Public Health Emergency of International Concern (PHEIC) Global research and innovation forum. Geneva: WHO; 2020 [cited 2025 Mar 20]. Available from: https://www.who.int/publications/m/item/covid-19-public-health-emergency-of-international-concern-(pheic)-global-research-and-innovation-forum
     [Google Scholar]
  3. Kadri SS, Sun J, Lawandi A, Strich JR, Busch LM, Keller M, . Association between caseload surge and COVID-19 survival in 558 U.S. hospitals, March to August 2020.. Ann Intern Med. 2021 09; 174:(9):1240-51. [Crossref]
     https://doi.org/10.7326/M21-1213 [Google Scholar]
  4. Rahmani K, Shavaleh R, Forouhi M, Ansari-Moghaddam A, Ranjbaran M, Zare F, . The effectiveness of COVID-19 vaccines in reducing the incidence, hospitalization, and mortality from COVID-19: A systematic review and meta-analysis.. Front Public Health. 2022 08;26: 10:873596. [Crossref]
     https://doi.org/10.3389/fpubh.2022.873596 [Google Scholar]
  5. Centers for Disease Control and Prevention . Coronavirus Disease 2019 (COVID-19). Atlanta: CDC; 2025 01; 31 [cited 2025 Mar 20]. Available from: https://www.cdc.gov/covid/index.html
     [Google Scholar]
  6. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): A review. JAMA. 2020 08; 25 324:(8):782–93. [Crossref]
     https://doi.org/10.1001/jama.2020.12839 [Google Scholar]
  7. Nguyen NT, Chinn J, Kirby K, Hohmann SF, Amin A. Outcomes of COVID-19 adults managed in an outpatient versus hospital setting. PLOS ONE. 2022 02 14; 17:(2):e0263813. [Crossref]
     https://doi.org/10.1371/journal.pone.0263813 [Google Scholar]
  8. Lyons PG, Edelson DP, Churpek MM. Rapid response systems. Resuscitation. 2018 05 16; 128::191-7. [Crossref]
     https://doi.org/10.1016/j.resuscitation.2018.05.013 [Google Scholar]
  9. Jones M. NEWSDIG: The National Early Warning Score Development and Implementation Group. Clin Med (Lond). 2012 12; 12:(6):501-3. [Crossref]
     https://doi.org/10.7861/clinmedicine.12-6-501 [Google Scholar]
  10. Royal College of Physicians . National Early Warning Score (NEWS) 2. London: RCP; 201712 19 [cited 2023 Nov 8]. Available from: https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2
     [Google Scholar]
  11. Stenhouse C, Coates S, Tivey M, Allsop P, Parker T. Prospective evaluation of a modified Early Warning Score to aid earlier detection of patients developing critical illness on a general surgical ward. Br J Anaesth. 2000 05; 84:(5):663P. [Crossref]
     https://doi.org/10.1093/bja/84.5.663 [Google Scholar]
  12. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, . Defining community acquired pneumonia severity on presentation to hospital: An international derivation and validation study.. Thorax. 2003 05; 58:(5):377-82. [Crossref]
     https://doi.org/10.1136/thorax.58.5.377 [Google Scholar]
  13. Bauer TT, Ewig S, Marre R, Suttorp N, Welte T, CAPNETZ Study Group. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006 07; 260:(1):93-101. [Crossref]
     https://doi.org/10.1111/j.1365-2796.2006.01657.x [Google Scholar]
  14. Santana AR, Amorim FF, Soares FB, LG Souza Godoy, Jesus Almeida L, Rodrigues TA, . Comparison of CURB-65 and CRB-65 as predictors of death in community-acquired pneumonia in adults admitted to an ICU.. Crit Care. 2013 06 19; 17:Suppl 3:P39. [Crossref]
     https://doi.org/10.1186/cc12655 [Google Scholar]
  15. Duca A, Piva S, Focà E, Latronico N, Rizzi M. Calculated decisions: Brescia-COVID respiratory severity scale (BCRSS)/algorithm. Emerg Med Pract. 2020 04 16;:22(5 Suppl):CD1-2. Available from: https://pubmed.ncbi.nlm.nih.gov/32297727/
     [Google Scholar]
  16. Haimovich AD, Ravindra NG, Stoytchev S, Young HP, Wilson FP, van Dijk D, . Development and validation of the quick COVID-19 severity index: A prognostic tool for early clinical decompensation.. Ann Emerg Med. 2020 10; 76:(4):442-53. [Crossref]
     https://doi.org/10.1016/j.annemergmed.2020.07.022 [Google Scholar]
  17. Williams B. The National Early Warning Score: From concept to NHS implementation. Clin Med (Lond). 2022 11; 22:(6):499-505. [Crossref]
     https://doi.org/10.7861/clinmed.2022-news-concept [Google Scholar]
  18. Morgan R, Lloyd-Williams F, Wright MM, Morgan-Warren RJ, An early warning scoring system for detecting developing critical illness. ScienceOpen; 1997 [cited 2025 Mar 20]. Available from: https://www.scienceopen.com/document?vid=28251d22-8476-40a6-916d-1a34796816e4
     [Google Scholar]
  19. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988 09; 44:(3):837-45. [Crossref]
     https://doi.org/10.2307/2531595 [Google Scholar]
  20. Bonanad C, García-Blas S, Tarazona-Santabalbina F, Sanchis J, Bertomeu-González V, Fácila L, . The effect of age on mortality in patients with COVID-19: A meta-analysis with 611,583 subjects.. J Am Med Dir Assoc. 2020 07; 21:(7):915-8. [Crossref]
     https://doi.org/10.1016/j.jamda.2020.05.045 [Google Scholar]
  21. AlNuaimi AA, Chemaitelly H, Semaan S, AlMukdad S, Al-Kanaani Z, Kaleeckal AH, . All-cause and COVID-19 mortality in Qatar during the COVID-19 pandemic.. BMJ Glob Health. 2023 05; 8:(5):e012291 [Crossref]
     https://doi.org/10.1136/bmjgh-2023-012291 [Google Scholar]
  22. Ibrahim W, Mahmood R, Farag E, Bansal D, Alfaki M, Al-Romaihi HE, . Assessing the variation in COVID-19 severity among the different nationalities living in Qatar.. Cureus. 2024 [Accessed 2025 Mar 20]. Available from: https://www.cureus.com/articles/230171-assessing-the-variation-in-covid-19-severity-among-the-different-nationalities-living-in-qatar#!/
     [Google Scholar]
  23. Khatib MY, Ananthegowda DC, Elshafei MS, El‐Zeer H, Abdaljawad WI, Shaheen MA, . Predictors of mortality and morbidity in critically ill COVID-19 patients: An experience from a low mortality country.. Health Sci Rep. 2022 05; 17 5:3:e542. [Crossref]
     https://doi.org/10.1002/hsr2.542 [Google Scholar]
  24. Syed MA, Al Nuaimi AS, A/Qotba HA, Nasrallah GK, Althani AA, Yassine HM, . Epidemiology of SARS-CoV2 in Qatar’s primary care population aged 10 years and above.. BMC Infect Dis. 2021; 21:(1):645. [Crossref]
     https://doi.org/10.1186/s12879-021-06251-z [Google Scholar]
  25. Goodacre S, Thomas B, Sutton L, Burnsall M, Lee E, Bradburn M, . Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: The PRIEST observational cohort study.. PLoS One. 2021 01 22; 16:(1):e0245840. [Crossref]
     https://doi.org/10.1371/journal.pone.0245840 [Google Scholar]
  26. Paraskevas T, Michailides C, Karalis I, Kantanis A, Chourpiliadi C, Matthaiakaki E, . External validation of the 4C mortality score and PRIEST COVID-19 clinical severity score in patients hospitalized with COVID-19 pneumonia in Greece.. Rom J Intern Med. 2022 1123; 60:(4):244-9. [Crossref]
     https://doi.org/10.2478/rjim-2022-0015 [Google Scholar]
  27. Suh EH, Lang KJ, Zerihun LM. Modified PRIEST score for identification of very low-risk COVID patients. Am J Emerg Med. 2021 09; 47::213-6. [Crossref]
     https://doi.org/10.1016/j.ajem.2021.04.063 [Google Scholar]
  28. Rodriguez-Nava G, Yanez-Bello MA, Trelles-Garcia DP, Chung CW, Friedman HJ, Hines DW. Performance of the quick COVID-19 severity index and the Brescia-COVID respiratory severity scale in hospitalized patients with COVID-19 in a community hospital setting. Int J Infect Dis. 2021 01; 102:571-6. [Crossref]
     https://doi.org/10.1016/j.ijid.2020.11.003 [Google Scholar]
  29. Castro Villamor MA, Alonso-Sanz M, López-Izquierdo R, Delgado Benito JF, Pozo Vegas C, Torres SL, . Comparison of eight prehospital early warning scores in life-threatening acute respiratory distress: A prospective, observational, multicentre, ambulance-based, external validation study.. Lancet Digit Health. [Accessed 2025 March 20]. Available from: https://www.thelancet.com/journals/landig/article/PIIS2589-7500(23)00243-1/fulltext
     [Google Scholar]
  30. Gidari A, De Socio GV, Sabbatini S, Francisci D. Predictive value of National Early Warning Score 2 (NEWS2) for intensive care unit admission in patients with SARS-CoV-2 infection. Infect Dis (Lond). 2020 10; 52:(10):698-704. [Crossref]
     https://doi.org/10.1080/23744235.2020.1784457 [Google Scholar]
  31. Myrstad M, Ihle-Hansen H, Tveita AA, Andersen EL, Nygård S, Tveit A, . National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from COVID-19 – A prospective cohort study.. Scand J Trauma Resusc Emerg Med. 2020 07;13 28:1:66. [Crossref]
     https://doi.org/10.1186/s13049-020-00764-3 [Google Scholar]
  32. Cr P, Vanidassane I, Pownraj D, Kandasamy R, Basheer A. National Early Warning Score 2 (NEWS2) to predict poor outcome in hospitalised COVID-19 patients in India. PLoS One. 2021 12 15; 16:(12):e0261376. [Crossref]
     https://doi.org/10.1371/journal.pone.0261376. [Google Scholar]
  33. Thomas B, Goodacre S, Lee E, Sutton L, Bursnall M, Loban A, . Prognostic accuracy of emergency department triage tools for adults with suspected COVID-19: The PRIEST observational cohort study.. Emerg Med J. 2021 08; 38:(8):587-93. [Crossref]
     https://doi.org/10.1136/emermed-2020-210783 [Google Scholar]
  34. Richter T, Tesch F, Schmitt J, Koschel D, Kolditz M. Validation of the qSOFA and CRB-65 in SARS-CoV-2-infected community-acquired pneumonia. ERJ Open Res. 2023 06 19; 9:(3):00168-2023. [Crossref]
     https://doi.org/10.1183/23120541.00168-2023 [Google Scholar]
  35. Fan G, Tu C, Zhou F, Liu Z, Wang Y, Song B, . Comparison of severity scores for COVID-19 patients with pneumonia: A retrospective study.. Eur Respir J. 2020 09;10 56:3:2002113. [Crossref]
     https://doi.org/10.1183/13993003.02113-2020 [Google Scholar]
  36. Hu H, Yao N, Qiu Y. Comparing rapid scoring systems in mortality prediction of critically ill patients with novel coronavirus disease. Acad Emerg Med. 2020 06; 27:(6):461-8. [Crossref]
     https://doi.org/10.1111/acem.13992 [Google Scholar]
  37. Hu H, Yao N, Qiu Y. Predictive value of 5 Early warning scores for critical COVID-19 patients. Disaster Med Public Health Prep. 2022 02; 16:(1):232-9. [Crossref]
     https://doi.org/10.1017/dmp.2020.324 [Google Scholar]
  38. Marincowitz C, Hodkinson P, McAlpine D, Fuller G, Goodacre S, Bath PA, . Prognostic accuracy of triage tools for adults with suspected COVID-19 in a middle-income setting: derivation and validation of the LMICPRIEST score.. PLoS One. 2023 06; 18:(6):e0287091. [Crossref]
     https://doi.org/10.1371/journal.pone.0287091 [Google Scholar]
/content/journals/10.5339/avi.2025.11
Loading
Comparative analysis of clinical scores for predicting COVID-19 severity and mortality: A retrospective prognostic study
Avicenna 2025, 11 (2025); https://doi.org/10.5339/avi.2025.11
/content/journals/10.5339/avi.2025.11
/content/journals/10.5339/avi.2025.11
Loading

Data & Media loading...

Supplements



  • Article Type: Research Article
Keyword(s): COVID-19, early warning systems, ICU admission, mortality, prognostic scores and risk stratification

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error