C-TIME

C-TIME predicts mortality and terminal extubation with hospice discharge at the time of endotracheal intubation for adult patients with SARS-CoV-2 pneumonia using clinical and laboratory variables available prior to intubation.

Key Features:

• Targeted application: Tailored for adult patients with SARS-CoV-2 pneumonia undergoing endotracheal intubation and benchmarked against APACHE IVa and SOFA.
• Comprehensive variable integration: Uses 25 clinical and laboratory variables collected within 48 hours before intubation, including age, gender, COPD, minimum mean arterial pressure, Glasgow Coma Scale score, PaO2/FiO2 ratio, maximum creatinine and bilirubin, factor Xa inhibitor use, duration of non-invasive respiratory support, and corticosteroid administration.
• Model development and validation: Developed from a retrospective cohort of consecutive adult SARS-CoV-2 patients who underwent endotracheal intubation across 18 medical-surgical ICUs and validated in an independent patient cohort.
• Predictive accuracy: Demonstrated an AUROC of 0.75 (95% CI: 0.72–0.79) for predicting mortality or terminal extubation with hospice discharge, exceeding the discriminant accuracy of APACHE IVa and SOFA.

Scientific Applications:

• Clinical risk stratification: Provides a pre-intubation prognostic estimate to inform discussions about prognosis, consent, and end-of-life options for mechanically ventilated COVID-19 patients.
• Mortality predictor research: Enables analysis and quantification of pre-intubation clinical and laboratory predictors of mortality in SARS-CoV-2 patients and comparison with established scores such as APACHE IVa and SOFA.

Methodology:

Retrospective cohort study of consecutive adult patients with confirmed SARS-CoV-2 who underwent endotracheal intubation across 18 medical-surgical ICUs, analyzed using multiple logistic regression and validated in an independent cohort.