COVID-19 Evidence Alerts
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Clinical Prediction Guide van Dam PM, Zelis N, Stassen P, et al. Validating the RISE UP score for predicting prognosis in patients with COVID-19 in the emergency department: a retrospective study. BMJ Open. 2021 Feb 5;11(2):e045141. doi: 10.1136/bmjopen-2020-045141.
Abstract

OBJECTIVE: To mitigate the burden of COVID-19 on the healthcare system, information on the prognosis of the disease is needed. The recently developed Risk Stratification in the Emergency Department in Acutely ill Older Patients (RISE UP) score has very good discriminatory value for short-term mortality in older patients in the emergency department (ED). It consists of six readily available items. We hypothesised that the RISE UP score could have discriminatory value for 30-day mortality in ED patients with COVID-19.

DESIGN: Retrospective analysis.

SETTING: Two EDs of the Zuyderland Medical Centre, secondary care hospital in the Netherlands.

PARTICIPANTS: The study sample consisted of 642 adult ED patients diagnosed with COVID-19 between 3 March and until 25 May 2020. Inclusion criteria were (1) admission to the hospital with symptoms suggestive of COVID-19 and (2) positive result of the PCR or (very) high suspicion of COVID-19 according to the chest CT scan.

OUTCOME: Primary outcome was 30-day mortality, secondary outcome was a composite of 30-day mortality and admission to intensive care unit (ICU).

RESULTS: Within 30 days after presentation, 167 patients (26.0%) died and 102 patients (15.9%) were admitted to ICU. The RISE UP score showed good discriminatory value for 30-day mortality (area under the receiver operating characteristic curve (AUC) 0.77, 95% CI 0.73 to 0.81) and for the composite outcome (AUC 0.72, 95% CI 0.68 to 0.76). Patients with RISE UP scores below 10% (n=121) had favourable outcome (zero deaths and six ICU admissions), while those with scores above 30% (n=221) were at high risk of adverse outcome (46.6% mortality and 19.0% ICU admissions).

CONCLUSION: The RISE UP score is an accurate prognostic model for adverse outcome in ED patients with COVID-19. It can be used to identify patients at risk of short-term adverse outcome and may help guide decision-making and allocating healthcare resources.

Ratings
Discipline / Specialty Area Score
Internal Medicine
Emergency Medicine
Comments from MORE raters

Emergency Medicine rater

This retrospective of 642 adult patients with COVID-19 (confirmed by PCR or suspicious CT) evaluated use of the RISE UP score in predicting 30 day mortality. The score was originally created to evaluated those >65 and incorporates an equation with age, vital signs, LDH, BUN, albumin, and bilirubin. A score < 5 demonstrated 98.6% sensitivity, while a score >50 demonstrated a sensitivity of 20.5% and specificity of 93%. However, AUC for 30 day mortality was 0.77, less than the original article. This study included patients from 2 EDs and 1 medical center, limiting generalizability. Further study is needed.