CURB-65 plus hypoalbuminemia: a new score system for prediction of the in-hospital mortality risk in patients with SARS-CoV-2 pneumonia

Oliva, Alessandra; Borrazzo, Cristian; Mascellino, Maria Teresa; Curtolo, Ambrogio; Ismail, Dania Al; Cancelli, Francesca; Galardo, Gioacchino; Bucci, Tommaso; Ceccarelli, Giancarlo; d’Ettorre, Gabriella; Pugliese, Francesco; Mastroianni, C. M.; Venditti, Mario

doi:10.53854/liim-2903-12

Cited by 6 publications

(6 citation statements)

References 33 publications

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“…In particular, the presence of liver damage seems to be quite common in COVID-19 patients with an estimated prevalence of patients with elevated aspartate aminotransferase (AST) of 23.2% and alanine aminotransferase (ALT) of 21.2% [ 5 ]. In addition, several evidence suggested that liver injury is associated with a more severe SARS-CoV-2 infection [ 6 – 8 ], especially when liver damage was defined by raised AST [ 5 ]. The presence of liver damage was also shown to represent a negative prognostic factor for COVID-19 patients [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department

Bucci

Galardo²,

Gandini³

et al. 2022

Intern Emerg Med

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Liver damage worsens the prognosis of coronavirus 19 disease (COVID-19). However, the best strategy to stratify mortality risk according to liver damage has not been established. The aim of this study is to test the predictive value of the validated Fibrosis-4 (FIB-4) Index and compared it to liver transaminases and to the AST-to-Platelet ratio index (APRI). Multicenter cohort study including 992 consecutive COVID-19 patients admitted to the Emergency Department. FIB-4 > 3.25 and APRI > 0.7 were used to define liver damage. Multivariable Cox regression and ROC curve analysis for mortality were performed. Secondary endpoints were (1) need for high-flow oxygen and (2) mechanical ventilation. 240 (24.2%) patients had a FIB-4 > 3.25. FIB-4 > 3.25 associated with an increased mortality (n = 119, log-rank test p < 0.001 and adjusted hazard ratio (HR) 1.72 (95% confidence interval [95%CI] 1.14–2.59, p = 0.010). ROC analysis for mortality showed that FIB-4 (AUC 0.734, 95% CI 0.705–0.761) had a higher predictive value than AST (p = 0.0018) and ALT (p < 0.0001). FIB-4 > 3.25 was also superior to APRI > 0.7 (AUC 0.58, 95% CI 0.553–0.615, p = 0.0008). Using an optimized cut-off > 2.76 (AUC 0.689, 95% CI 0.659–0.718, p < 0.0001), FIB-4 was superior to FIB-4 > 3.25 (p = 0.0302), APRI > 0.7 (p < 0.0001), AST > 51 (p = 0.0119) and ALT > 42 (p < 0.0001). FIB-4 was also associated with high-flow oxygen use (n = 255, HR 1.69, 95% CI 1.25–2.28, p = 0.001) and mechanical ventilation (n = 39, HR 2.07, 95% CI 1.03–4.19, p = 0.043). FIB-4 score predicts mortality better than liver transaminases and APRI score. FIB-4 score may be an easy tool to identify COVID-19 patients at worse prognosis in the emergency department.

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Section: Introductionmentioning

confidence: 99%

Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department

Bucci

Galardo²,

Gandini³

et al. 2022

Intern Emerg Med

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“…qSOFA (AUROC 0.818; 95% CI 0.786–0.850), CURB-65 (AUROC 0.859; 95% CI 0.823–0.896), Expanded CURB-65 (AUROC 0.836; 95% CI 0.800–0.873) and MEWS (AUROC 0.870; 95% CI 0.842–0.898) scores were inferior in predicting in-hospital mortality of patients with COVID-19 pneumonia, as confirmed by previous studies with the results of AUROC for qSOFA 0.73 (95% CI 0.69–0.78), CURB-65 0.85 (95% CI 0.81–0.89) [ 16 ], qSOFA 0.63 (95% CI 0.6–0.66), CURB 65 0.74 (95% CI 0.72–0.77) [ 72 ], MEWS 0.670 (95% CI 0.573–0.767) [ 17 ], MEWS 0.586 (95% CI 0.531–0.640), qSOFA 0.673 (95% CI 0.620–0.723) [ 73 ], expanded CURB-65 0.885 (95% CI 0.827–0.942) [ 74 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Pneumonia Severity Indices, qCSI, 4C-Mortality Score and qSOFA in Predicting Mortality in Hospitalized Patients with COVID-19 Pneumonia

Akıllı

Bilge

Guz

et al. 2022

JPM

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This is a retrospective and observational study on 1511 patients with SARS-CoV-2, who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. 1511 patients, 879 male (58.17%) and 632 female (41.83%) with a mean age of 60.1 ± 14.7 were included in the study. Survivors and non-survivors groups were statistically compared with respect to survival, discharge, ICU admission and in-hospital death. Although gender was not statistically significant different between two groups, 80 (60.15%) of the patients who died were male. Mean age was 72.8 ± 11.8 in non-survivors vs. 59.9 ± 14.7 in survivors (p < 0.001). Overall in-hospital mortality was found to be 8.8% (133/1511 cases), and overall ICU admission was 10.85% (164/1511 cases). The PSI/PORT score of the non-survivors group was higher than that of the survivors group (144.38 ± 28.64 versus 67.17 ± 25.63, p < 0.001). The PSI/PORT yielding the highest performance was the best predictor for in-hospital mortality, since it incorporates the factors as advanced age and comorbidity (AUROC 0.971; % 95 CI 0.961–0.981). The use of A-DROP may also be preferred as an easier alternative to PSI/PORT, which is a time-consuming evaluation although it is more comprehensive.

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“… Alavi-Moghaddam et al, 2013 [ 20 ], Ozkan et al, 2020 [ 21 ], Fuchs Bahlis et al, 2021 [ 2 ], Esteban Ronda et al, 2021 [ 22 ], Feng et al, 2021 [ 3 ], Lazar Neto et al, 2021 [ 6 ], Estella, 2015 [ 23 ], Demirel, 2018 [ 24 ], Holten et al, 2020 [ 25 ], Olivia et al, 2021 [ 26 ], Cupurdija et al, 2015 [ 27 ], Anurag and Preetam, 2021 [ 5 ], Ranzani et al, 2017 [ 28 ], Günaydın et al, 2019 [ 29 ], Tsai et al, 2021 [ 30 ], Wen et al, 2020 [ 31 ], Putot et al, 2016 [ 7 ], Wang et al, 2020 [ 32 ], Bloom et al, 2019 [ 33 ], Williams et al, 2018 [ 34 ], Kim et al, 2013 [ 10 ], Aydin et al, 2019 [ 35 ], Akpınar et al, 2019 [ 36 ], Ito et al, 2017 [ 37 ], Lee et al, 2013 [ 38 ] …”

Section: Reviewmentioning

confidence: 99%

“…The included studies covered a broad scope of countries across the globe. Out of 25 studies, only one study [ 5 ] did not report data comparing PSI and CURB-65 in mortality, and 19 studies [ 2 , 3 , 6 , 10 , 20 - 23 , 25 , 26 , 28 , 29 , 32 - 38 ] reported data on the need for intensive care support. The size of the studies varied from 24 patients [ 23 ] to up to 6874 in the cohort study of Spain [ 28 ].…”

Section: Reviewmentioning

confidence: 99%

The Battle of the Pneumonia Predictors: A Comprehensive Meta-Analysis Comparing the Pneumonia Severity Index (PSI) and the CURB-65 Score in Predicting Mortality and the Need for ICU Support

Zaki¹,

Alkahlout²,

Shaban³

et al. 2023

Cureus

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The CURB-65 (confusion, uremia, respiratory rate, blood pressure, age ≥ 65 years) score and the pneumonia severity index (PSI) are widely used and recommended in predicting 30-day mortality and the need for intensive care support in community-acquired pneumonia. This study aims to compare the performance of these two severity scores in both mortality prediction and the need for intensive care support. A systematic review and meta-analysis was carried out, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 guidelines, and PubMed, Scopus, ScienceDirect, and Google Scholar were searched for articles published from 2012 to 2022. The reference lists of the included studies were also searched to retrieve possible additional studies. Twenty-five studies reporting prognostic information for CURB 65 and PSI were identified. ReviewManager (RevMan) 5.4.1 was used to produce risk ratios, and a random effects model was used to pool them. Both PSI and CURB-65 showed a high strength in identifying high-risk patients. However, CURB-65 was slightly better in early mortality prediction and had more sensitivity (96.7%) and specificity (89.3%) in predicting admission to intensive care support. Thus, CURB-65 seems to be the preferred tool in predicting mortality and the need for admission into intensive care support.

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CURB-65 plus hypoalbuminemia: a new score system for prediction of the in-hospital mortality risk in patients with SARS-CoV-2 pneumonia

Cited by 6 publications

References 33 publications

Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department

Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department

Comparison of Pneumonia Severity Indices, qCSI, 4C-Mortality Score and qSOFA in Predicting Mortality in Hospitalized Patients with COVID-19 Pneumonia

The Battle of the Pneumonia Predictors: A Comprehensive Meta-Analysis Comparing the Pneumonia Severity Index (PSI) and the CURB-65 Score in Predicting Mortality and the Need for ICU Support

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