TY - JOUR
T1 - Low CRB-65 scores effectively rule out adverse clinical outcomes in COVID-19 irrespective of chest radiographic abnormalities
AU - Liu, Alexander Qichen
AU - Hammond, Robert
AU - Chan, Kenneth
AU - Chukwuenweniwe, Chukwugozie
AU - Johnson, Rebecca
AU - Khair, Duaa
AU - Duck, Eleanor
AU - Olubodun, Oluwaseun
AU - Barwick, Kirstian
AU - Banya, Winston
AU - Stirrup, James
AU - Donnelly, Peter Duncan
AU - Kaski, Juan Carlos
AU - Coates, Anthony R M
PY - 2023/8/30
Y1 - 2023/8/30
N2 - 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.
AB - 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.
KW - Coronavirus disease 2019
KW - CRB-65
KW - Chest X-ray
KW - Diagnostic performance
KW - Inflammatory markers
KW - Prognosis
KW - Risk stratification
KW - COVID-19
U2 - 10.3390/biomedicines11092423
DO - 10.3390/biomedicines11092423
M3 - Article
SN - 2227-9059
VL - 11
JO - Biomedicines
JF - Biomedicines
IS - 9
M1 - 2423
ER -