RISK STRATIFICATION OF PATIENTS ADMITTED WITH COVID -19 TO A TERTIARY CARE HOSPITA IN PUDUCHERRY USING ISARIC-4C MORATLITY SCORE

Abstract

Background : Risk stratification of patients is the most important aspect in COVID-19 management. Prioritizing critical care services in situations of overwhelming numbers of patients is an absolute necessity. Globally many scoring systems have been specifically developed for risk stratification in COVID-19 patients. The ISARIC/WHO 4C Mortality score is a well validated risk stratification score. It is observed that the Covid disease present differently in different regions of the world. Hence the applicability of the ISARIC- 4C score in the Indian population needs to be studied. Aims & Objectives : The study was aimed (1) to find the association of various clinical and laboratory parameters as used by ISARIC/WHO 4C Mortality score with COVID19 mortality in a tertiary covid care centre. (2) to find the effectiveness of ISARIC-4C mortality score in predicting the in-hospital COVID19 mortality and validating its use in our population. Methods and Materials: This is a single centre; retrospective medical record based observational study undertaken at a tertiary care hospital. 160 lab confirmed covid positive patients ≥18 years admitted in our institute during the peak of covid 2^nd wave (May1, 2021 to May 31, 2021) were included. These 160 patients were divided into 2 groups. Group 1 had 80 patients who were treated and discharged and group 2 had 80 patients who died of the disease. The clinical data and laboratory parameters were retrospectively analysed from the health records of these patients. Data was compared between patients who were discharged and succumbed to death. Result: Age was significantly associated with the outcome of the patient. Higher age (age more than 60 years) had significantly higher proportion of deaths (58.8%) on comparison. Higher number of comorbidities (comorbidities more than 2) had significantly higher proportion of deaths (11.3%). There was significantly higher respiratory rate and lower SPO2, GCS score among those with bad outcome (death). There was a significantly higher CRP value among those with bad outcome (death). 4C Mortality risk score was significantly higher among those with bad outcome (death). Compared to those with Low &Intermediate risk, COVID 19 patients with High &Very high risk had 15.7 times higher chance of mortality which was significant. The Sensitivity analysis found that the risk stratification High & Very high risk had a sensitivity of 81.3% and specificity of 78.8% to detect bad outcome (death). The overall diagnostic accuracy was 80%. Conclusion: According to our study, the ISARIC 4C mortality score is highly predictive of in-hospital mortality and can be used to stratify and predict mortality in COVID-19 patients on admission to the hospital. It is an adaptable and good prognostic tool for use in Indian emergency departments and hospitals.

KEYWORD: ISARIC/WHO 4C Mortality score ( ISARIC/WHO 4C:  International Severe Acute Respiratory And Emerging Infections Consortium / World Health Organisation-Coronavirus Clinical Characterisation Consortium)