Desenvolvimento de novos sistemas de pontuação de severidade para pacientes de UTI

Abstract

Objetives: i) determine whether modification of the neurologic compononent of SOFA outperforms the unmodified score, ii) develop novel age calibrated score iii) determine whether a pneumonia specific score outperforms common ICU and pneumonia severity scores and evaluate the performance of this score in a multi-center COVID-19 ICU cohort. Methods: Prospective cohort studies of adult ICU patients hospitalized at Hospital de Cidade in Salvador, Bahia, Brazil followed by a multi-center prospective cohort study of adults hospitalized in the ICU of COVID treatment centers in Bahia. Results: Modification of the neurologic component SOFA with either a novel score for defining neurologic system deficits, Full Outline of UnResponsiveness (FOUR) or Richmond Agitation-Sedation Score (RASS) did not improve prediction of ICU mortality (SOFA-GCS AUC = 0.74 vs SOFA-RASS AUC = 0.71 and SOFA-FOUR AUC = 0.67). A novel Age Calibrated ICU Score (ACIS) outperformed the SAPS3 score in prediction of mortality in our ICU cohort (AUC = 0.80 vs 0.72). The pneumonia shock score demonstrated signficant performance improvement (AUC = 0.80) over existing ICU and pneumonia severity scores including SAPS 3, qSOFA, CURB-65, and CRB-65 (AUC = 0.74, 0.64, 0.65, and 0.63, respectively). The calibrated score subsequently performed well in those admitted to the ICU with SARSCoV- 2 infection (AUC = 0.80). Conclusion: Given the advanced age of our cohort and likelihood of an increasingy elderly ICU population worldwide, we demonstrated that the novel age calibrated severity score outperformed SAPS3, offering a tool that may serve to help triage limited resources to those most likely to survive their critical illness. The calibrated pneumonia shock score accurately idenitifed those at risk for ICU mortality from pneumonia in both pre- and post-COVID cohorts. This offers another simple bedside tool to help accurately assign individuals based on severity in subsequent clinical trials.