Prognostic value of REDS, SOFA, and D-dimer in critically ill COVID-19 patients with sepsis

Abstract

Introduction/Objective Early identification of high-risk patients with COVID-19-associated sepsis is essential for timely intervention and optimal ICU resource allocation. This study aimed to evaluate and compare the prognostic performance of risk-stratification of emergency department sepsis (REDS) and sequential organ failure assessment (SOFA) scores, alongside D-dimer levels, in predicting 28-day mortality among critically ill patients.

Methods A retrospective analysis was conducted on 163 critically ill adult patients with confirmed COVID-19 and sepsis (Sepsis-3 criteria) admitted to the intensive care unit of a tertiary center between November 2020 and May 2022. REDS, SOFA, and D-dimer values were assessed within 24 hours of ICU admission. Predictive value was evaluated using ROC analysis, logistic regression, and χ² automatic interaction detector (CHAID) decision tree modeling.

Results The overall 28-day mortality rate was 65.6%. REDS (AUC = 0.690) and SOFA (AUC = 0.680) demonstrated moderate predictive ability, while D-dimer showed lower accuracy (AUC = 0.632). REDS > 2 had the highest sensitivity (80.2%), and SOFA > 4 had the highest specificity (56.1%). Both REDS and SOFA were identified as independent mortality predictors. CHAID analysis recognized REDS as the strongest discriminator, stratifying mortality risk into three distinct groups (42.9%, 66.1%, and 84.5%).

Conclusion REDS and SOFA scores provide meaningful prognostic value in patients with COVID-19-related sepsis. REDS demonstrated a slight advantage and may serve as a simple and effective bedside tool for early risk stratification in clinical practice and future viral pandemics.

Keywords: COVID-19; sepsis; REDS score; SOFA score; prognosis; mortality