Rapid Emergency Medicine Scores in the Prediction of Adverse Outcomes in Patients with SARS-CoV-2: A Scoping Review and Meta-Analysis

AIM OF THE STUDY. To evaluate the prognostic value of rapid scoring systems in predicting mortality and adverse outcomes in patients with COVID-19 (novel coronavirus infection).

MATERIALS AND METHODS. A literature search was conducted in the PubMed, eLibrary, and Science Gate databases. The prognostic value of the rapid scoring systems was assessed using a meta-analysis of AUROC (Area Under the Receiver Operating Characteristic curve), which predicted mortality and adverse outcomes (ICU admission, organ support, or death) in patients with COVID-19. Data were statistically processed using MedCalc 20.027 and Microsoft Office Excel 2019.

RESULTS. Sixty studies involving a total of 619,494 patients were included in the systematic review and meta-analysis. Five scoring systems were used for predicting hospital mortality: NEWS, NEWS2, REMS, qSOFA, and the SIRS criteria. The REMS scale demonstrated the best results, with an AUC of 0.808 (95% CI 0.776–0.839), while the SIRS criteria showed the lowest prognostic value, with an AUC of 0.662 (95% CI 0.596–0.728). The NEWS, NEWS2, and qSOFA scales also demonstrated good results, with AUC ranging from 0.722 to 0.782. However, all scales showed high heterogeneity (I² > 96%), suggesting variability in populations and study conditions. The same scales were used to predict the severe course of COVID-19. In this context, NEWS and NEWS2 showed the greatest effectiveness, with an AUC of 0.778 (95% CI 0.707–0.849 and 95% CI 0.738–0.819, respectively). The REMS scale showed an AUC of 0.733 (95% CI 0.708–0.757) with minimal heterogeneity (I² = 0.0%), while the qSOFA scale had an AUC of 0.662 (95% CI 0.606–0.717) and the SIRS criteria had an AUC of 0.607 (95% CI 0.511–0.702). High heterogeneity was observed for the NEWS, NEWS2, and qSOFA scales (I² from 82.4% to 99.6%), which further suggests variability in study conditions.

CONCLUSIONS. The data suggest that the REMS, NEWS, NEWS2, and qSOFA scales can be used in clinical practice as prognostic tools for assessing the risk of hospital mortality and severe outcomes in COVID-19 patients.