Low CRB-65 Scores Effectively Rule out Adverse Clinical Outcomes in COVID-19 Irrespective of Chest Radiographic Abnormalities
<b>Background:</b> CRB-65 (<b>C</b>onfusion; <b>R</b>espiratory rate ≥ 30/min; <b>B</b>lood pressure ≤ 90/60 mmHg; age ≥ <b>65</b> years) is a risk score for prognosticating patients with COVID-19 pneumonia. However, a significant proportio...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-08-01
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| Series: | Biomedicines |
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| Online Access: | https://www.mdpi.com/2227-9059/11/9/2423 |
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| author | Alexander Liu Robert Hammond Kenneth Chan Chukwugozie Chukwuenweniwe Rebecca Johnson Duaa Khair Eleanor Duck Oluwaseun Olubodun Kristian Barwick Winston Banya James Stirrup Peter D. Donnelly Juan Carlos Kaski Anthony R. M. Coates |
| author_facet | Alexander Liu Robert Hammond Kenneth Chan Chukwugozie Chukwuenweniwe Rebecca Johnson Duaa Khair Eleanor Duck Oluwaseun Olubodun Kristian Barwick Winston Banya James Stirrup Peter D. Donnelly Juan Carlos Kaski Anthony R. M. Coates |
| author_sort | Alexander Liu |
| collection | DOAJ |
| description | <b>Background:</b> CRB-65 (<b>C</b>onfusion; <b>R</b>espiratory rate ≥ 30/min; <b>B</b>lood pressure ≤ 90/60 mmHg; age ≥ <b>65</b> 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. <b>Methods:</b> We assessed the influence of CXR abnormalities on the prognostic value of CRB-65 in COVID-19. <b>Results:</b> 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 <i>p</i> < 0.05). <b>Conclusions:</b> 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. |
| first_indexed | 2024-03-10T23:00:47Z |
| format | Article |
| id | doaj.art-dacec034922740b6b498f8609afadd25 |
| institution | Directory Open Access Journal |
| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-03-10T23:00:47Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj.art-dacec034922740b6b498f8609afadd252023-11-19T09:41:05ZengMDPI AGBiomedicines2227-90592023-08-01119242310.3390/biomedicines11092423Low CRB-65 Scores Effectively Rule out Adverse Clinical Outcomes in COVID-19 Irrespective of Chest Radiographic AbnormalitiesAlexander Liu0Robert Hammond1Kenneth Chan2Chukwugozie Chukwuenweniwe3Rebecca Johnson4Duaa Khair5Eleanor Duck6Oluwaseun Olubodun7Kristian Barwick8Winston Banya9James Stirrup10Peter D. Donnelly11Juan Carlos Kaski12Anthony R. M. Coates13School of Medicine, University of St Andrews, St Andrews KY16 9TF, UKSchool of Medicine, University of St Andrews, St Andrews KY16 9TF, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKRoyal Brompton Hospital, London SW3 6NP, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKSchool of Medicine, University of St Andrews, St Andrews KY16 9TF, UKMolecular and Clinical Sciences Research Institute, St George’s University of London, London SW17 0QT, UKInstitute of Infection and Immunity, St George’s University of London, London SW17 0QT, UK<b>Background:</b> CRB-65 (<b>C</b>onfusion; <b>R</b>espiratory rate ≥ 30/min; <b>B</b>lood pressure ≤ 90/60 mmHg; age ≥ <b>65</b> 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. <b>Methods:</b> We assessed the influence of CXR abnormalities on the prognostic value of CRB-65 in COVID-19. <b>Results:</b> 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 <i>p</i> < 0.05). <b>Conclusions:</b> 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.https://www.mdpi.com/2227-9059/11/9/2423coronavirus disease 2019CRB-65chest X-raydiagnostic performanceinflammatory markersprognosis |
| spellingShingle | Alexander Liu Robert Hammond Kenneth Chan Chukwugozie Chukwuenweniwe Rebecca Johnson Duaa Khair Eleanor Duck Oluwaseun Olubodun Kristian Barwick Winston Banya James Stirrup Peter D. Donnelly Juan Carlos Kaski Anthony R. M. Coates Low CRB-65 Scores Effectively Rule out Adverse Clinical Outcomes in COVID-19 Irrespective of Chest Radiographic Abnormalities Biomedicines coronavirus disease 2019 CRB-65 chest X-ray diagnostic performance inflammatory markers prognosis |
| title | Low CRB-65 Scores Effectively Rule out Adverse Clinical Outcomes in COVID-19 Irrespective of Chest Radiographic Abnormalities |
| title_full | Low CRB-65 Scores Effectively Rule out Adverse Clinical Outcomes in COVID-19 Irrespective of Chest Radiographic Abnormalities |
| title_fullStr | Low CRB-65 Scores Effectively Rule out Adverse Clinical Outcomes in COVID-19 Irrespective of Chest Radiographic Abnormalities |
| title_full_unstemmed | Low CRB-65 Scores Effectively Rule out Adverse Clinical Outcomes in COVID-19 Irrespective of Chest Radiographic Abnormalities |
| title_short | Low CRB-65 Scores Effectively Rule out Adverse Clinical Outcomes in COVID-19 Irrespective of Chest Radiographic Abnormalities |
| title_sort | low crb 65 scores effectively rule out adverse clinical outcomes in covid 19 irrespective of chest radiographic abnormalities |
| topic | coronavirus disease 2019 CRB-65 chest X-ray diagnostic performance inflammatory markers prognosis |
| url | https://www.mdpi.com/2227-9059/11/9/2423 |
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