Low CRB-65 scores effectively rule out adverse clinical outcomes in COVID-19 irrespective of chest radiographic abnormalities

Authors: Liu, Alexander;

Hammond, Robert;

Chan, Kenneth;

Chukwuenweniwe, Chukwugozie;

Johnson, Rebecca;

Khair, Duaa;

Duck, Eleanor;

Olubodun, Oluwaseun;

Barwick, Kristian;

Banya, Winston;

Stirrup, James;

Donnelly, Peter D.;

Kaski, Juan Carlos;

Coates, Anthony R.M.

Source: Biomedicines

Full text

: https://doi.org/10.3390/biomedicines11092423

Abstract

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 < 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.

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Copyright © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

Cite as

Liu, A., Hammond, R., Chan, K., Chukwuenweniwe, C., Johnson, R., Khair, D., Duck, E., Olubodun, O., Barwick, K., Banya, W., Stirrup, J., Donnelly, P., Kaski, J. & Coates, A. 2023, 'Low CRB-65 scores effectively rule out adverse clinical outcomes in COVID-19 irrespective of chest radiographic abnormalities', Biomedicines, 11(9), article no: 2423. https://doi.org/10.3390/biomedicines11092423

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DOI: https://doi.org/10.3390/biomedicines11092423

Repository URI: http://hdl.handle.net/10023/28261