Performance of clinical risk assessment tools to predict outcomes among patients assessed at the emergency department with coronavirus disease 2019 infection

Bushra Kurban¹Adnan Agha¹Lutfi Kurban²Virgie Guy¹Javed Yasin¹Fayez Alshamsi¹Mohamed Ismail^1,3Omran Bakoush^1*

• ¹Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
• ²Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
• ³Department of Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates

The coronavirus disease 2019 (COVID-19) pandemic resulted in significant global mortality and morbidity, with emerging mutant strains continuing to potentially precipitate severe respiratory illness. Two clinical assessment tools, namely, the COVID-19 Risk of Complications Score (CRS), based on 13 comorbidities, and the ALKA (age, lactate dehydrogenase, kidney function, and albumin) score have been developed to predict disease severity among patients who are symptomatic at presentation. This study aimed to compare the performance of these two risk-scoring systems in predicting hospital admission, critical illness, and mortality. Methods: This retrospective study included 368 patients diagnosed with COVID-19 at SEHA hospitals in Al Ain over a six-month period. The CRS and ALKA scores were calculated to predict hospital admission, critical illness, and mortality. Predictive ability was assessed using receiver operating characteristic (ROC) curve analysis. Odds ratios (ORs) were calculated to assess the risk of hospital admission, critical illness, and mortality. Results: The mean age of the patients was 51 ± 19.42 years, and 145 (39.4%) of them were male. Among the patients, 162 required inpatient care, 13 required invasive ventilation, and the mortality rate was 4.9% (eight patients). ROC analysis revealed that ALKA outperformed CRS in predicting hospital admission (ALKA area under the curve [AUC] 0.79 vs. CRS AUC 0.71), critical illness (ALKA AUC 0.76 vs. CRS AUC 0.67), and mortality (ALKA AUC 0.96 vs. CRS AUC 0.82). The OR for ALKA outperformed CRS in predicting hospital admission (ALKA 3.12 vs. CRS 1.12), critical illness (ALKA 2.9 vs. CRS 2.01), and mortality (ALKA 6.25 vs. CRS 1.1). Conclusion: Our study demonstrated that ALKA score outperforms CRS in predicting hospital admission, critical illness, and mortality among patients with symptomatic COVID-19 at initial presentation. Further external validation of both tools is required to assess their effectiveness in different healthcare settings.