Publication date: Jul 29, 2025

The coronavirus disease 2019 (COVID-19) pandemic has led to the development of numerous prognostic models for patient assessment. However, the potential utility of the predisposition, insult/infection, response, organ dysfunction (PIRO) score in evaluating COVID-19 severity and outcomes remains unexplored, presenting a gap in current research. A retrospective analysis was conducted on a cohort of 374 individuals diagnosed with COVID-19 who were admitted to the emergency department of Beijing Youan Hospital. Demographic data, treatment regimens, and seven prognostic scoring systems, including PIRO, were evaluated. To evaluate the models’ prognostic accuracy for 28-day mortality, area under the receiver operating characteristic (AUROC) analysis was employed. Comparative performance between scoring systems was quantified using the DeLong method for paired ROC curves. Of the 374 patients meeting inclusion criteria, 120 (32. 1%) died within 28 day of hospitalization. Significant disparities were observed between survivors and non-survivors regarding age, laboratory parameters, and clinical scores. Analysis of patient distribution and mortality rates across different score ranges revealed a positive correlation between score magnitude and 28-day mortality. The PIRO score demonstrated superior prognostic capability, yielding an AUC of 0. 898 (95% CI 0. 866-0. 929). The quick sequential organ failure assessment (qSOFA) score followed closely (AUC 0. 882, 95% CI 0. 849-0. 914). Both critical illness risk score (COVID-GRAM) and national early warning score 2 (NEWS2) exhibited AUCs exceeding 0. 85 (COVID-GRAM 0. 854, 95% CI 0. 812-0. 895; NEWS2: 0. 851, 95% CI 0. 813-0. 889). DeLong test analysis revealed statistically significant differences in AUC between PIRO and confusion, urea, respiration, systolic pressure, age ≥ 65 (CURB-65), pneumonia severity index (PSI), COVID-GRAM, rapid acute physiology score (RAPS), and NEWS2 (all p 

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