Utility of severity assessment tools in COVID-19 pneumonia: a multicentre observational study

Abstract

BackgroundSeverity scores in pneumonia and sepsis are being applied to SARS-CoV-2 infection. We aimed to assess whether these severity scores are accurate predictors of early adverse outcomes in COVID-19. MethodsWe conducted a multicentre observational study of hospitalised SARS-CoV-2 infection. We assessed risk scores (CURB65, qSOFA, Lac-CURB65, MuLBSTA and NEWS2) in relation to admission to intensive care or death within 7 days of admission, defined as early severe adverse events (ESAE). The 4C Mortality Score was also assessed in a sub-cohort of patients. FindingsIn 2,387 participants, the overall mortality was 18%. In all scores examined, increasing score was associated with increased risk of ESAE. Area under the curve (AUC) to predict ESAE for CURB65, qSOFA, Lac-CURB65, MuLBSTA and NEWS2 were 0.61, 0.62, 0.59, 0.59 and 0.68, respectively. AUC to predict ESAE was 0.60 with ISARIC 4C Mortality Score. ConclusionNone of the scores examined accurately predicted ESAE in SARS-CoV-2 infection. Non-validated scores should not be used to inform clinical decision making in COVID-19.

Performance of CURB-65 and ISARIC 4C mortality scores for hospitalized patients with confirmed COVID-19 infection in Saudi Arabia

“…Demir et al reported better performance in predicting COVID-19 mortality with 83.33% sensitivity, 90.43% specificity, and 0.942 AUC [ 16 ]. However, other authors have raised concerns about the reliance on the CURB-65 score to guide clinical decision-making in COVID-19 patient care, despite showing statistically significant differences in distinguishing between survivors and non-survivors, and there is an argument that the CURB-65 score is incapable of accurately estimating COVID-19-associated mortality due to the complexity and specific characteristics of COVID-19 disease and the presence of many risk factors [ 25 , 26 ]. Our study results indicates a good performance of the CURB-65 score as a prognostic tool, estimating patient mortality with a sensitivity of 75.00%, a specificity of 82.31%, YJI 0.57, AUC 0.834, and P < 0.0001, which supports its use for rapid triage of COVID-19 patients.…”

Asia Pacific perspectives on the second year of the COVID‐19 pandemic: A follow‐up survey

“…Remdesivir, 33 dexamethasone 34 and other immunomodulatory drugs 35 like baricitinib continue to be used for those with severe disease, requiring oxygen to avoid progression to mechanical ventilation (where possible) and reduce the risk of dying. Management strategies are increasingly guided by the use of objective risk assessment measures of disease severity in both vaccinated and unvaccinated to prognosticate outcomes, e.g., the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) score 36,37 …”

“…27,28 Vaccine-induced thrombotic thrombocytopenia (VITT), although predominant in recipients of adenovirus vector vaccines, 29 does not appear to recur with the second dose regardless of the type of vaccine and remains rarely, if at all, associated with mRNA vaccines. 30 Thirdly, diagnostic tests like antigen rapid tests (ART) 31 36,37 Pre-exposure prophylaxis using Tixagevimab and Cilgavimab (Evusheld) is now also available. 38…”