Immunocompromised Patients with Acute Respiratory Failure: “Don’t Wait to Intubate”?

renal subscore.Again, although in some cases the adjusted scores were less poorly calibrated than the original score, differences in performance between Black and white patients remained.The results of these analyses suggest that other factors associated with Black versus white race were contributing to the calibration errors.This study is timely, of critical importance in the midst of the COVID-19 pandemic, and reinforces the necessity of examining each component of our public health and acute healthcare delivery systems for race-based disparities and inequities.The large size and multicenter nature of the population as well as the study's rigorous statistical approach and well-conceived sensitivity analyses are important strengths.However, the use of a non-COVID-19 patient population and the focus solely on mortality prediction scores rather than also evaluating full CSC scoring systems makes interpretation of these results in light of the pandemic or comparison to other studies, such as that by Gershengorn and colleagues (6), challenging.Given concerns that scoringsystems may be biased against nonwhite persons as well as the overwhelming evidence of higher prevalence and worse outcomes associated with COVID-19 among nonwhite communities, authors of some CSCs have proposed the use of correction factors that give credits to minoritized or disadvantaged groups.One example is the Area Deprivation Index, which uses a person's address to rank their degree of socioeconomic disadvantage (5, 8, 9), although this does not explicitly address the racial differences in calibration identified in thisstudy.TheuseofsuchcorrectionfactorsinCSCsisjustoneexampleof several potential approaches to address the systematic racial disparities identified by Dr. Ashana and colleagues.This important study highlights the crucial need for more research, validation, and refinement of CSC scoring systems to ensure that they achieve their goals of equitable distribution of resources while maximizing lives or life-years saved.