Prognostic performance of the Age, PaO2/FiO2 Ratio, and Plateau Pressure Score (APPS) for mortality in patients with COVID-19-associated acute respiratory distress syndrome admitted to an intensive care unit

Gutierrez-Zamudio A.A.M.; Alejandro-Salinas R.; Vereau-Robles J.I.; Toro-Huamanchumo C.J. · Therapeutic Advances in Infectious Disease (2024) · DOI: 10.1177/20499361241306212

Resumen

Background: A predictive scoring system used in patients with acute respiratory distress syndrome (ARDS) known as Age, PaO2/FiO2, Plateau Pressure Score (APPS) has been externally validated to predict mortality in Asian and Caucasian populations. Its performance in Latin American and COVID-19 patients still needs to be done. Objective: To assess the association between APPS and mortality, as well as APPS performance in predicting mortality within 28 days of intensive care unit (ICU) admission in patients with ARDS due to COVID-19. Design: Analytical observational retrospective cohort study. Methods: We conducted a retrospective cohort study in patients diagnosed with ARDS according to the Berlin criteria who were admitted to the ICU. We evaluated the prognostic performance of APPS using the area under the receiver operating characteristic curve (AUC-ROC), and association with mortality was measured using the Cox proportional hazards regression models. Results: A total of 271 patients were analyzed. The AUC for 28-day mortality was 0.78 (95% CI: 0.73–0.84). In the Cox proportional hazards model, after adjusting for sex and categorized Charlson Comorbidity Index, it was found that grade 2 APPS (aHR: 3.67, 95% CI: 2.14–6.30, p < 0.001) and grade 3 APPS (aHR: 7.95, 95% CI: 3.72–17.02, p < 0.001) were associated with a higher hazard of 28-day mortality. Conclusion: The APPS scoring system has a good prognostic performance for mortality in patients diagnosed with COVID-19-induced ARDS. © The Author(s), 2024.; How well the APPS score predicts risk of death in COVID-19 patients with severe lung problems When someone is severely ill with COVID-19 and has trouble breathing, doctors often use a score called APPS to predict how likely they are to survive. The APPS score looks at three things: the patient’s age, their oxygen levels (measured by the PaO2/FiO2 ratio), and the pressure needed by a ventilator to help them breathe (plateau pressure). We studied whether this score works well in predicting the survival of patients with COVID-19 who were admitted to intensive care units. By reviewing the medical records of 271 patients, we found that the APPS score is quite good at predicting who might not survive the next 28 days. Patients with higher APPS scores had a greater risk of dying within this period. This finding helps doctors better understand a patient’s condition and possibly tailor their treatment more effectively. © The Author(s), 2024.

Instituciones: Universidad Peruana de Ciencias Aplicadas; Universidad San Ignacio de Loyola