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

Alexander Qichen Liu, Robert Hammond, Kenneth Chan, Chukwugozie Chukwuenweniwe, Rebecca Johnson, Duaa Khair, Eleanor Duck, Oluwaseun Olubodun, Kirstian Barwick, Winston Banya, James Stirrup, Peter Duncan Donnelly, Juan Carlos Kaski, Anthony R M Coates*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Downloads (Pure)

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.
Original languageEnglish
Article number2423
JournalBiomedicines
Volume11
Issue number9
DOIs
Publication statusPublished - 30 Aug 2023

Keywords

  • Coronavirus disease 2019
  • CRB-65
  • Chest X-ray
  • Diagnostic performance
  • Inflammatory markers
  • Prognosis
  • Risk stratification
  • COVID-19

Fingerprint

Dive into the research topics of 'Low CRB-65 scores effectively rule out adverse clinical outcomes in COVID-19 irrespective of chest radiographic abnormalities'. Together they form a unique fingerprint.

Cite this