Liu, A;
Hammond, R;
Chan, K;
Chukwuenweniwe, C;
Johnson, R;
Khair, D;
Duck, E;
Olubodun, O;
Barwick, K;
Banya, W;
et al.
Liu, A; Hammond, R; Chan, K; Chukwuenweniwe, C; Johnson, R; Khair, D; Duck, E; Olubodun, O; Barwick, K; Banya, W; Stirrup, J; Donnelly, PD; Kaski, JC; Coates, ARM
(2023)
Low CRB-65 Scores Effectively Rule out Adverse Clinical Outcomes in COVID-19 Irrespective of Chest Radiographic Abnormalities.
Biomedicines, 11 (9).
p. 2423.
ISSN 2227-9059
https://doi.org/10.3390/biomedicines11092423
SGUL Authors: Kaski, Juan Carlos Coates, Anthony Robert Milnes
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Abstract
Background: CRB-65 (Confusion; Respiratory rate ≥ 30/min; Blood 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.
Item Type: | Article | ||||||
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Additional Information: | © 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/) | ||||||
SGUL Research Institute / Research Centre: | Academic Structure > Infection and Immunity Research Institute (INII) Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) |
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Journal or Publication Title: | Biomedicines | ||||||
ISSN: | 2227-9059 | ||||||
Language: | en | ||||||
Dates: |
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Publisher License: | Creative Commons: Attribution 4.0 | ||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/115653 | ||||||
Publisher's version: | https://doi.org/10.3390/biomedicines11092423 |
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