Development and validation of SCOPE score: A clinical score to predict COVID-19 pneumonia progression to severe respiratory failure

Most patients infected with SARS-CoV-2 (COVID-19) experience mild, non-specific symptoms, but many develop severe symptoms associated with an excessive inflammatory response. Elevated plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) provide early warning of progression to severe respiratory failure (SRF) or death, but access to suPAR testing may be limited. The Severe COvid Prediction Estimate (SCOPE) score, derived from circulating concentrations of C-reactive protein, D- dimers, interleukin-6, and ferritin among patients not receiving non-invasive or invasive mechanical ventilation during the SAVE-MORE study, offers predictive accuracy for progression to SRF or death within 14 days comparable to that of a suPAR concentration of ≥6 ng/mL (area under receiver operator characteristic curve 0.81 for both). The SCOPE score is validated in two similar independent cohorts. A SCOPE score of 6 or more is an alternative to suPAR for predicting progression to SRF or death within 14 days of hospital admission for pneumonia, and it can be used to guide treatment decisions. [Display omitted] •SCOPE score is composed of C-reactive protein, D dimers, ferritin, and interleukin-6•Values of 6 or more predict 6-fold risk for severe respiratory failure or death•SCOPE score predicts risk for severe respiratory failure or death comparable to suPAR•Anakinra treatment when SCOPE is 6 or more provides lower odds of poor outcome Giamarellos-Bourboulis et al. introduce the SCOPE score for early prognostication of the risk for severe respiratory failure or death within the next 14 days in COVID-19 pneumonia. This is composed of C-reactive protein, D dimers, ferritin, and interleukin-6 concentrations. Anakinra treatment administered when SCOPE is 6 or more provides lower odds of a poor outcome.