TY - JOUR
AU - Liu, Alexander
AU - Hammond, Robert
AU - Chan, Kenneth
AU - Chukwuenweniwe, Chukwugozie
AU - Johnson, Rebecca
AU - Khair, Duaa
AU - Duck, Eleanor
AU - Olubodun, Oluwaseun
AU - Barwick, Kristian
AU - Banya, Winston
AU - Stirrup, James
AU - Donnelly, Peter D.
AU - Kaski, Juan Carlos
AU - Coates, Anthony R.M.
PY - 2023
DA - August
TI - Low CRB-65 scores effectively rule out adverse clinical outcomes in COVID-19 irrespective of chest radiographic abnormalities
JO - Biomedicines
VL - 11
IS - 9
DO - https://doi.org/10.3390/biomedicines11092423
AB - Background: CRB-65 ( C onfusion; R espiratory rate ≥ 30/min; B lood pressure ≤ 90/60 mmHg; age ≥ 65 years) is a risk score for prognosticating patients with COVID-19 pneumonia. However, a significant proportion of COVID-19 patients have normal chest X-rays (CXRs). The influence of CXR abnormalities on the prognostic value of CRB-65 is unknown, limiting its wider applicability. Methods: We assessed the influence of CXR abnormalities on the prognostic value of CRB-65 in COVID-19. Results: In 589 study patients (71 years (IQR: 57–83); 57% males), 186 (32%) had normal CXRs. On ROC analysis, CRB-65 performed similarly in patients with normal vs. abnormal CXRs for predicting inpatient mortality (AUC 0.67 ± 0.05 vs. 0.69 ± 0.03). In patients with normal CXRs, a CRB-65 of 0 ruled out mortality, NIV requirement and critical illness (intubation and/or ICU admission) with negative predictive values (NPVs) of 94%, 98% and 99%, respectively. In patients with abnormal CXRs, a CRB-65 of 0 ruled out the same endpoints with NPVs of 91%, 83% and 86%, respectively. Patients with low CRB-65 scores had better inpatient survival than patients with high CRB-65 scores, irrespective of CXR abnormalities (all p &lt; 0.05). Conclusions: CRB-65, CXR and CRP are independent predictors of mortality in COVID-19. Adding CXR findings (dichotomised to either normal or abnormal) to CRB-65 does not improve its prognostic accuracy. A low CRB-65 score of 0 may be a good rule-out test for adverse clinical outcomes in COVID-19 patients with normal or abnormal CXRs, which deserves prospective validation.
PB - MDPI
UR - http://hdl.handle.net/10023/28261
KW - Coronavirus (COVID-19)
KW - Digital health and technology
ER