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Prognostic Scoring System for Mortality of Hospitalized COVID-19 Patients in Resource-Limited Settings: A Multicenter Study from COVID-19 Referral Hospitals

Siti Rizny F. Saldi, Eka Dian Safitri, Siti Setiati, Respati W Ranakusuma, Jessica Marsigit, Muhammad K Azwar, Puji Astuti, Cut Yulia Indah Sari, Rahmi Istanti, Mira Yulianti, Cleopas Martin Rumende, Evy Yunihastuti, Adityo Susilo, Kuntjoro Harimurti, Lies Dina Liastuti, Trimartani Trimartani, Ratna Dwi Restuti, Ari Fahrial Syam

Abstract


Background: Many studies identified the risk factors and prognostic factors related to in-hospital COVID-19 mortality using sophisticated laboratory tests. Cost and the availability of supporting blood tests may be problematic in resource-limited settings. This multicenter cohort study was conducted to assess the factors associated with mortality of COVID-19 patients aged 18 years and older, based on history taking, physical examination, and simple blood tests to be used in resource-limited settings. Methods: The study was conducted between July 2020 and January 2021 in five COVID-19 referral hospitals in Indonesia. Among 1048 confirmed cases of COVID-19, 160 (15%) died during hospitalization. Results: Multivariate analysis showed eight predictors of in-hospital mortality, namely increased age, chronic kidney disease, chronic obstructive pulmonary disease, fatigue, dyspnea, altered mental status, neutrophil-lymphocyte ratio (NLR) ≥ 5.8, and severe-critical condition. This scoring system had an Area-under-the-curve (AUC) of 84.7%. With cut-off score of 6, the sensitivity was 76.3% and the specificity was 78.2%. Conclusion: The result of this practical prognostic scoring system may be a guide to decision making of physicians and help in the education of family members related to the possible outcome.

Keywords


COVID-19; prognostic; predictive score; mortality; resource-limited settings

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