The utility of established prognostic scores in COVID-19 hospital admissions: a multi-centre prospective evaluation of CURB-65, NEWS2, and qSOFA

Bradley, Patrick, Frost, Freddy ORCID: 0000-0002-3902-6502, Tharmaratnam, Kukatharmini ORCID: 0000-0002-8255-9822 and Wootton, Daniel Gower ORCID: 0000-0002-5903-3881
(2020) The utility of established prognostic scores in COVID-19 hospital admissions: a multi-centre prospective evaluation of CURB-65, NEWS2, and qSOFA. BMJ Open Respiratory Research, 7 (1).

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<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>The COVID-19 pandemic is ongoing yet, due to the lack of a COVID-19 specific tool, clinicians must use pre-existing illness severity scores for initial prognostication. However, the validity of such scores in COVID-19 is unknown.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The North West Collaborative Organization for Respiratory Research (NW-CORR) performed a multi-centre prospective evaluation of adult patients admitted to hospital with confirmed COVID-19 during a two-week period in April 2020. Clinical variables measured as part of usual care at presentation to hospital were recorded, including the CURB-65, NEWS2, and qSOFA scores. The primary outcome of interest was 30-day mortality.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Data were collected for 830 people with COVID-19 admitted across 7 hospitals. By 30 days, a total of 300 (36.1%) had died and 142 (17.1%) had been in ICU. All scores underestimated mortality compared to their original validation in non-COVID-19 populations, and overall prognostic performance was generally poor. Among the ‘low risk’ categories (CURB-65&lt;2, NEWS2&lt;5, qSOFA&lt;2) 30-day mortality was 16.7%, 32.9% and 21.4%, respectively. Multivariable logistic regression identified features of respiratory compromise rather than circulatory collapse as most relevant prognostic variables.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>All existing prognostic scores evaluated here underestimated adverse outcomes and performed sub-optimally in the COVID-19 setting. New prognostic tools including a focus on features of respiratory compromise rather than circulatory collapse are needed. We provide a baseline set of variables which are relevant to COVID-19 outcomes and may be used as a basis for developing a bespoke COVID-19 prognostication tool.</jats:p></jats:sec><jats:sec><jats:title>Key Messages</jats:title><jats:list list-type="bullet"><jats:list-item><jats:p><jats:bold>What is the key question?</jats:bold></jats:p><jats:p>Do well-established illness severity scores have prognostic value in COVID-19?</jats:p></jats:list-item><jats:list-item><jats:p><jats:bold>What is the bottom line?</jats:bold></jats:p><jats:p>All scores appeared to underestimate mortality in COVID-19 and prognostic performance was generally poor, and importantly could not discriminate those patients at very low risk of death within 30 days.</jats:p></jats:list-item><jats:list-item><jats:p><jats:bold>Why read on?</jats:bold></jats:p><jats:p>In this multi-centre prospective evaluation of CURB-65, NEWS2 and qSOFA we comprehensively evaluate score performance and also identify variables which may be of use in COVID-19 prognostication.</jats:p></jats:list-item></jats:list></jats:sec>

Item Type: Article
Uncontrolled Keywords: NW-CORR Collaborators
Depositing User: Symplectic Admin
Date Deposited: 11 Dec 2020 11:10
Last Modified: 25 Feb 2023 16:15
DOI: 10.1101/2020.07.15.20154815
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