tetano
Editor, Senior Moderator
Clin Infect Dis
. 2025 Jan 10:ciaf006.
doi: 10.1093/cid/ciaf006. Online ahead of print. Predicting the risk of intensive care unit admission in patients with COVID-19 presenting in the emergency room: Development and evaluation of the CROSS score
Weiwei Xiang[SUP] 1 [/SUP], Fridolin Steinbeis[SUP] 1 [/SUP], Kiret Dhindsa[SUP] 2 [/SUP], Florian Kurth[SUP] 1 3 4 [/SUP], Tilman Lingscheid[SUP] 1 [/SUP], Charlotte Thibeault[SUP] 1 2 [/SUP], Hans-Jakob Meyer[SUP] 1 [/SUP], Norbert Suttorp[SUP] 1 [/SUP], Mirja Mittermaier[SUP] 2 [/SUP], Melanie Stecher[SUP] 5 6 [/SUP], Margarete Scherer[SUP] 5 7 [/SUP], Marina Hagen[SUP] 7 [/SUP], Lazar Mitrov[SUP] 5 [/SUP], Ramsia Geisler[SUP] 5 7 [/SUP], Katharina S Appel[SUP] 5 7 [/SUP], Sina M Hopff[SUP] 5 6 [/SUP], Carolin Koll[SUP] 5 [/SUP], Susana M Nunes de Miranda[SUP] 5 [/SUP], Christina Weismantel[SUP] 7 [/SUP], Jens-Peter Reese[SUP] 8 9 [/SUP], Peter Heuschmann[SUP] 8 9 10 [/SUP], Olga Miljukov[SUP] 8 9 [/SUP], Carolin Nürnberger[SUP] 8 9 [/SUP], Leif-Erik Sander[SUP] 11 12 [/SUP], Jörg Janne Vehreschild[SUP] 7 [/SUP], Martin Witzenrath[SUP] 1 [/SUP], Maarten van Smeden[SUP] 13 [/SUP], Thomas Zoller[SUP] 1 [/SUP]
Affiliations
Background: Existing risk evaluation tools underperform in predicting intensive care unit (ICU) admission for patients with the Coronavirus Disease 2019 (COVID-19). This study aimed to develop and evaluate an accurate and calculator-free clinical tool for predicting ICU admission at emergency room (ER) presentation.
Methods: Data from patients with COVID-19 in a nationwide German cohort (March 2020-January 2023) were analyzed. Candidate predictors were selected based on literature and clinical expertise. A risk score, predicting ICU admission within seven days of ER presentation, was developed using elastic net logistic regression on a northern German cohort (derivation cohort), evaluated on a southern German cohort (evaluation cohort) and externally validated on a Colombian cohort. Performance was evaluated through discrimination, calibration, and clinical utility against existing tools.
Results: ICU admission rates within seven days were 30.8% (derivation cohort, n=1295, median age 60, 38.1% female), 28.1% (evaluation cohort, n=1123, median age 58, 36.9% female), and 30.3% (Colombian cohort, n=780, median age 57, 38.8% female). The 11-point CROSS score, based on Confusion, Respiratory rate, Oxygen Saturation (with or without concurrent supplemental oxygen), and oxygen Supplementation, demonstrated good discrimination (area under the curve (AUC): 0.77 in the evaluation cohort; 0.69 in the Colombian cohort), good calibration, and superior clinical utility compared to existing tools. Mortality-predicting tools performed poorly in predicting ICU admission risk for patients with COVID-19.
Conclusions: The calculator-free CROSS score effectively predicts ICU admission for patients with COVID-19 in the ER. Further studies are needed to assess its generalizability in other settings. Mortality-predicting tools are not recommended for ICU admission prediction.
Keywords: Respiratory infections; elastic net logistic regression; emergency service; prognosis; triage.
. 2025 Jan 10:ciaf006.
doi: 10.1093/cid/ciaf006. Online ahead of print. Predicting the risk of intensive care unit admission in patients with COVID-19 presenting in the emergency room: Development and evaluation of the CROSS score
Weiwei Xiang[SUP] 1 [/SUP], Fridolin Steinbeis[SUP] 1 [/SUP], Kiret Dhindsa[SUP] 2 [/SUP], Florian Kurth[SUP] 1 3 4 [/SUP], Tilman Lingscheid[SUP] 1 [/SUP], Charlotte Thibeault[SUP] 1 2 [/SUP], Hans-Jakob Meyer[SUP] 1 [/SUP], Norbert Suttorp[SUP] 1 [/SUP], Mirja Mittermaier[SUP] 2 [/SUP], Melanie Stecher[SUP] 5 6 [/SUP], Margarete Scherer[SUP] 5 7 [/SUP], Marina Hagen[SUP] 7 [/SUP], Lazar Mitrov[SUP] 5 [/SUP], Ramsia Geisler[SUP] 5 7 [/SUP], Katharina S Appel[SUP] 5 7 [/SUP], Sina M Hopff[SUP] 5 6 [/SUP], Carolin Koll[SUP] 5 [/SUP], Susana M Nunes de Miranda[SUP] 5 [/SUP], Christina Weismantel[SUP] 7 [/SUP], Jens-Peter Reese[SUP] 8 9 [/SUP], Peter Heuschmann[SUP] 8 9 10 [/SUP], Olga Miljukov[SUP] 8 9 [/SUP], Carolin Nürnberger[SUP] 8 9 [/SUP], Leif-Erik Sander[SUP] 11 12 [/SUP], Jörg Janne Vehreschild[SUP] 7 [/SUP], Martin Witzenrath[SUP] 1 [/SUP], Maarten van Smeden[SUP] 13 [/SUP], Thomas Zoller[SUP] 1 [/SUP]
Affiliations
- PMID: 39792903
- DOI: 10.1093/cid/ciaf006
Background: Existing risk evaluation tools underperform in predicting intensive care unit (ICU) admission for patients with the Coronavirus Disease 2019 (COVID-19). This study aimed to develop and evaluate an accurate and calculator-free clinical tool for predicting ICU admission at emergency room (ER) presentation.
Methods: Data from patients with COVID-19 in a nationwide German cohort (March 2020-January 2023) were analyzed. Candidate predictors were selected based on literature and clinical expertise. A risk score, predicting ICU admission within seven days of ER presentation, was developed using elastic net logistic regression on a northern German cohort (derivation cohort), evaluated on a southern German cohort (evaluation cohort) and externally validated on a Colombian cohort. Performance was evaluated through discrimination, calibration, and clinical utility against existing tools.
Results: ICU admission rates within seven days were 30.8% (derivation cohort, n=1295, median age 60, 38.1% female), 28.1% (evaluation cohort, n=1123, median age 58, 36.9% female), and 30.3% (Colombian cohort, n=780, median age 57, 38.8% female). The 11-point CROSS score, based on Confusion, Respiratory rate, Oxygen Saturation (with or without concurrent supplemental oxygen), and oxygen Supplementation, demonstrated good discrimination (area under the curve (AUC): 0.77 in the evaluation cohort; 0.69 in the Colombian cohort), good calibration, and superior clinical utility compared to existing tools. Mortality-predicting tools performed poorly in predicting ICU admission risk for patients with COVID-19.
Conclusions: The calculator-free CROSS score effectively predicts ICU admission for patients with COVID-19 in the ER. Further studies are needed to assess its generalizability in other settings. Mortality-predicting tools are not recommended for ICU admission prediction.
Keywords: Respiratory infections; elastic net logistic regression; emergency service; prognosis; triage.