Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA
Introduction The COVID-19 pandemic is ongoing, yet, due to the lack of a COVID-19-specific tool, clinicians must use pre-existing illness severity scores for initial prognostication. However, the validity of such scores in COVID-19 is unknown.Methods The North West Collaborative Organisation for Res...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-09-01
|
| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/7/1/e000729.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846158950336036864 |
|---|---|
| author | Ryan Robinson Charlotte King Patrick Bradley Ran Wang Alex Bull Ayesha Kumar Konstantinos Liatsikos Freddy Frost Kukatharmini Tharmaratnam Daniel G Wootton Mahin Ahmad Joshua Aigbirior Ruth Cade Kate Grant Farheen Kutubuddin Muhammed Haris Mir Eman Nasr Laurence Pearmain Rachel Penfold Sarika Raghunath Victoria Randles |
| author_facet | Ryan Robinson Charlotte King Patrick Bradley Ran Wang Alex Bull Ayesha Kumar Konstantinos Liatsikos Freddy Frost Kukatharmini Tharmaratnam Daniel G Wootton Mahin Ahmad Joshua Aigbirior Ruth Cade Kate Grant Farheen Kutubuddin Muhammed Haris Mir Eman Nasr Laurence Pearmain Rachel Penfold Sarika Raghunath Victoria Randles |
| author_sort | Ryan Robinson |
| collection | DOAJ |
| description | Introduction The COVID-19 pandemic is ongoing, yet, due to the lack of a COVID-19-specific tool, clinicians must use pre-existing illness severity scores for initial prognostication. However, the validity of such scores in COVID-19 is unknown.Methods The North West Collaborative Organisation for Respiratory Research performed a multicentre prospective evaluation of adult patients admitted to the hospital with confirmed COVID-19 during a 2-week period in April 2020. Clinical variables measured as part of usual care at presentation to the hospital were recorded, including the Confusion, Urea, Respiratory Rate, Blood Pressure and Age Above or Below 65 Years (CURB-65), National Early Warning Score 2 (NEWS2) and Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) scores. The primary outcome of interest was 30-day mortality.Results Data were collected for 830 people with COVID-19 admitted across seven hospitals. By 30 days, a total of 300 (36.1%) had died and 142 (17.1%) had been in the intensive care unit. All scores underestimated mortality compared with pre-COVID-19 cohorts, and overall prognostic performance was generally poor. Among the ‘low-risk’ categories (CURB-65 score<2, NEWS2<5 and qSOFA score<2), 30-day mortality was 16.7%, 32.9% and 21.4%, respectively. NEWS2≥5 had a negative predictive value of 98% for early mortality. Multivariable logistic regression identified features of respiratory compromise rather than circulatory collapse as most relevant prognostic variables.Conclusion In the setting of COVID-19, existing prognostic scores underestimated risk. The design of new prognostic tools should focus on features of respiratory compromise rather than circulatory collapse. We provide a baseline set of variables which are relevant to COVID-19 outcomes and may be used as a basis for developing a bespoke COVID-19 prognostication tool. |
| format | Article |
| id | doaj-art-ccb3718aa6d7488a980cb54d910e910c |
| institution | Kabale University |
| issn | 2052-4439 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj-art-ccb3718aa6d7488a980cb54d910e910c2024-11-24T10:45:07ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392020-09-017110.1136/bmjresp-2020-000729Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFARyan RobinsonCharlotte King0Patrick Bradley1Ran Wang2Alex BullAyesha KumarKonstantinos Liatsikos3Freddy Frost4Kukatharmini Tharmaratnam5Daniel G Wootton6Mahin AhmadJoshua AigbiriorRuth CadeKate GrantFarheen KutubuddinMuhammed Haris MirEman NasrLaurence PearmainRachel PenfoldSarika Raghunath7Victoria RandlesDepartment of Women and Child`s Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UKDepartment of Respiratory Medicine, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UKFaculty of Biology, Medicine and Health, School of Biological Sciences, Division of Immunology, Immunity to Infection & Respiratory Medicine, The University of Manchester, Manchester, UKLiverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UKDepartment of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK2Department of Health and Data Science, University of Liverpool, Liverpool, UKInstitute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UKRespiratory Medicine, Aintree site, Liverpool Hospitals NHS Foundation Trust, Liverpool, UKIntroduction The COVID-19 pandemic is ongoing, yet, due to the lack of a COVID-19-specific tool, clinicians must use pre-existing illness severity scores for initial prognostication. However, the validity of such scores in COVID-19 is unknown.Methods The North West Collaborative Organisation for Respiratory Research performed a multicentre prospective evaluation of adult patients admitted to the hospital with confirmed COVID-19 during a 2-week period in April 2020. Clinical variables measured as part of usual care at presentation to the hospital were recorded, including the Confusion, Urea, Respiratory Rate, Blood Pressure and Age Above or Below 65 Years (CURB-65), National Early Warning Score 2 (NEWS2) and Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) scores. The primary outcome of interest was 30-day mortality.Results Data were collected for 830 people with COVID-19 admitted across seven hospitals. By 30 days, a total of 300 (36.1%) had died and 142 (17.1%) had been in the intensive care unit. All scores underestimated mortality compared with pre-COVID-19 cohorts, and overall prognostic performance was generally poor. Among the ‘low-risk’ categories (CURB-65 score<2, NEWS2<5 and qSOFA score<2), 30-day mortality was 16.7%, 32.9% and 21.4%, respectively. NEWS2≥5 had a negative predictive value of 98% for early mortality. Multivariable logistic regression identified features of respiratory compromise rather than circulatory collapse as most relevant prognostic variables.Conclusion In the setting of COVID-19, existing prognostic scores underestimated risk. The design of new prognostic tools should focus on features of respiratory compromise rather than circulatory collapse. We provide a baseline set of variables which are relevant to COVID-19 outcomes and may be used as a basis for developing a bespoke COVID-19 prognostication tool.https://bmjopenrespres.bmj.com/content/7/1/e000729.full |
| spellingShingle | Ryan Robinson Charlotte King Patrick Bradley Ran Wang Alex Bull Ayesha Kumar Konstantinos Liatsikos Freddy Frost Kukatharmini Tharmaratnam Daniel G Wootton Mahin Ahmad Joshua Aigbirior Ruth Cade Kate Grant Farheen Kutubuddin Muhammed Haris Mir Eman Nasr Laurence Pearmain Rachel Penfold Sarika Raghunath Victoria Randles Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA BMJ Open Respiratory Research |
| title | Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA |
| title_full | Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA |
| title_fullStr | Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA |
| title_full_unstemmed | Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA |
| title_short | Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA |
| title_sort | utility of established prognostic scores in covid 19 hospital admissions multicentre prospective evaluation of curb 65 news2 and qsofa |
| url | https://bmjopenrespres.bmj.com/content/7/1/e000729.full |
| work_keys_str_mv | AT ryanrobinson utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT charlotteking utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT patrickbradley utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT ranwang utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT alexbull utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT ayeshakumar utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT konstantinosliatsikos utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT freddyfrost utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT kukatharminitharmaratnam utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT danielgwootton utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT mahinahmad utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT joshuaaigbirior utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT ruthcade utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT kategrant utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT farheenkutubuddin utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT muhammedharismir utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT emannasr utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT laurencepearmain utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT rachelpenfold utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT sarikaraghunath utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa AT victoriarandles utilityofestablishedprognosticscoresincovid19hospitaladmissionsmulticentreprospectiveevaluationofcurb65news2andqsofa |