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Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA.
Bradley, Patrick; Frost, Freddy; Tharmaratnam, Kukatharmini; Wootton, Daniel G.
  • Bradley P; Department of Respiratory Medicine, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
  • Frost F; Department of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
  • Tharmaratnam K; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
  • Wootton DG; Department of Health Data Science, University of Liverpool, Liverpool, UK.
BMJ Open Respir Res ; 7(1)2020 12.
Article in English | MEDLINE | ID: covidwho-962851
ABSTRACT

INTRODUCTION:

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.

METHODS:

The North West Collaborative Organisation for Respiratory Research performed a multicentre prospective evaluation of adult patients admitted to the hospital with confirmed COVID-19 during a 2-week period in April 2020. Clinical variables measured as part of usual care at presentation to the hospital were recorded, including the Confusion, Urea, Respiratory Rate, Blood Pressure and Age Above or Below 65 Years (CURB-65), National Early Warning Score 2 (NEWS2) and Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) scores. The primary outcome of interest was 30-day mortality.

RESULTS:

Data were collected for 830 people with COVID-19 admitted across seven hospitals. By 30 days, a total of 300 (36.1%) had died and 142 (17.1%) had been in the intensive care unit. All scores underestimated mortality compared with pre-COVID-19 cohorts, and overall prognostic performance was generally poor. Among the 'low-risk' categories (CURB-65 score<2, NEWS2<5 and qSOFA score<2), 30-day mortality was 16.7%, 32.9% and 21.4%, respectively. NEWS2≥5 had a negative predictive value of 98% for early mortality. Multivariable logistic regression identified features of respiratory compromise rather than circulatory collapse as most relevant prognostic variables.

CONCLUSION:

In the setting of COVID-19, existing prognostic scores underestimated risk. The design of new prognostic tools should focus on features of respiratory compromise rather than circulatory collapse. 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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Sepsis / SARS-CoV-2 / COVID-19 / Hospitalization Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Language: English Year: 2020 Document Type: Article Affiliation country: Bmjresp-2020-000729

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Sepsis / SARS-CoV-2 / COVID-19 / Hospitalization Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Language: English Year: 2020 Document Type: Article Affiliation country: Bmjresp-2020-000729