Prognostication of COVID-19 Patients Using ROX Index and CURB-65 Score - A Retrospective Observational Study

Overview

Journal J Family Med Prim Care

Specialty Public Health

Date 2023 Jan 9

PMID 36618245

Authors

Poonam Arora

Takshak Shankar

Shrirang Joshi

Aadya Pillai

Ankita Kabi

Rajnish K Arora

Meenakshi Khapre

Nilotpal Chowdhury

Affiliations

Soon will be listed here.

Abstract

Objectives: Coronavirus disease-2019 (COVID-19) disease has overwhelmed the healthcare infrastructure worldwide. The shortage of intensive care unit (ICU) beds leads to longer waiting times and higher mortality for patients. High crowding leads to an increase in mortality, length of hospital stays, and hospital costs for patients. Through an appropriate stratification of patients, rational allocation of the available hospital resources can be accomplished. Various scores for risk stratification of patients have been tried, but for a score to be useful at primary care level, it should be readily available at the bedside and be reproducible. ROX index and CURB-65 are simple bedside scores, requiring minimum equipment, and investigations to calculate.

Methods: This retrospective, record-based study included adult patients who presented to the ED from May 1, 2020 to November 30, 2020 with confirmed COVID-19 infection. The patient's clinical and demographic details were obtained from the electronic medical records of the hospital. ROX index and CURB-65 score on ED arrival were calculated and correlated with the need for hospitalization and early (14-day) and late (28-day) mortality.

Results: 842 patients were included in the study. The proportion of patients with mild, moderate and severe disease was 46.3%, 14.9%, and 38.8%, respectively. 55% patients required hospitalization. The 14-day mortality was 8.8% and the 28-day mortality was 20.7%. The AUROC of ROX index for predicting hospitalization was 0.924 (p < 0.001), for 14-day mortality was 0.909 (p < 0.001) and for 28-day mortality was 0.933 (p < 0.001). The AUROC of CURB-65 score for predicting hospitalization was 0.845 (p < 0.001), for 14-day mortality was 0.905 (p < 0.001) and for 28-day mortality was 0.902 (p < 0.001). The cut-off of ROX index for predicting hospitalization was ≤18.634 and for 14-day mortality was ≤14.122. Similar cut-off values for the CURB-65 score were ≥1 and ≥2, respectively.

Conclusion: ROX index and CURB-65 scores are simple and inexpensive scores that can be efficiently utilised by primary care physicians for appropriate risk stratification of patients with COVID-19 infection.

References

Wu Z, McGoogan J . Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239-1242. DOI: 10.1001/jama.2020.2648. View

Doganay F, Ak R . Performance of the CURB-65, ISARIC-4C and COVID-GRAM scores in terms of severity for COVID-19 patients. Int J Clin Pract. 2021; 75(10):e14759. PMC: 8646358. DOI: 10.1111/ijcp.14759. View

Guo J, Zhou B, Zhu M, Yuan Y, Wang Q, Zhou H . CURB-65 may serve as a useful prognostic marker in COVID-19 patients within Wuhan, China: a retrospective cohort study. Epidemiol Infect. 2020; 148:e241. PMC: 7573457. DOI: 10.1017/S0950268820002368. View

Garcia Clemente M, Herrero Huertas J, Fernandez Fernandez A, Escosura Munoz C, Enriquez Rodriguez A, Perez Martinez L . Assessment of risk scores in Covid-19. Int J Clin Pract. 2020; 75(12):e13705. DOI: 10.1111/ijcp.13705. View

Fan G, Tu C, Zhou F, Liu Z, Wang Y, Song B . Comparison of severity scores for COVID-19 patients with pneumonia: a retrospective study. Eur Respir J. 2020; 56(3). PMC: 7366179. DOI: 10.1183/13993003.02113-2020. View

Ahmad S, Kumar P, Shekhar S, Saha R, Ranjan A, Pandey S . Epidemiological, Clinical, and Laboratory Predictors of In-Hospital Mortality Among COVID-19 Patients Admitted in a Tertiary COVID Dedicated Hospital, Northern India: A Retrospective Observational Study. J Prim Care Community Health. 2021; 12:21501327211041486. PMC: 8388224. DOI: 10.1177/21501327211041486. View

Dhont S, Derom E, Van Braeckel E, Depuydt P, Lambrecht B . The pathophysiology of 'happy' hypoxemia in COVID-19. Respir Res. 2020; 21(1):198. PMC: 7385717. DOI: 10.1186/s12931-020-01462-5. View

Roca O, Caralt B, Messika J, Samper M, Sztrymf B, Hernandez G . An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy. Am J Respir Crit Care Med. 2018; 199(11):1368-1376. DOI: 10.1164/rccm.201803-0589OC. View

Wang Z, Deng H, Ou C, Liang J, Wang Y, Jiang M . Clinical symptoms, comorbidities and complications in severe and non-severe patients with COVID-19: A systematic review and meta-analysis without cases duplication. Medicine (Baltimore). 2020; 99(48):e23327. PMC: 7710213. DOI: 10.1097/MD.0000000000023327. View

10.

Gavriatopoulou M, Korompoki E, Fotiou D, Ntanasis-Stathopoulos I, Psaltopoulou T, Kastritis E . Organ-specific manifestations of COVID-19 infection. Clin Exp Med. 2020; 20(4):493-506. PMC: 7383117. DOI: 10.1007/s10238-020-00648-x. View

11.

Roca O, Messika J, Caralt B, Garcia-de-Acilu M, Sztrymf B, Ricard J . Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. J Crit Care. 2016; 35:200-5. DOI: 10.1016/j.jcrc.2016.05.022. View

12.

Gianstefani A, Farina G, Salvatore V, Alvau F, Artesiani M, Bonfatti S . Role of ROX index in the first assessment of COVID-19 patients in the emergency department. Intern Emerg Med. 2021; 16(7):1959-1965. PMC: 7917022. DOI: 10.1007/s11739-021-02675-2. View

13.

Carriel J, Munoz-Jaramillo R, Bolanos-Ladinez O, Heredia-Villacreses F, Menendez-Sanchon J, Martin-Delgado J . [CURB-65 as a predictor of 30-day mortality in patients hospitalized with COVID-19 in Ecuador: COVID-EC study]. Rev Clin Esp. 2020; 222(1):37-41. PMC: 7580560. DOI: 10.1016/j.rce.2020.10.001. View

14.

Lim W, van der Eerden M, Laing R, Boersma W, Karalus N, Town G . Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003; 58(5):377-82. PMC: 1746657. DOI: 10.1136/thorax.58.5.377. View

15.

Aujesky D, Auble T, Yealy D, Stone R, Obrosky D, Meehan T . Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med. 2005; 118(4):384-92. DOI: 10.1016/j.amjmed.2005.01.006. View

16.

Gallo Marin B, Aghagoli G, Lavine K, Yang L, Siff E, Chiang S . Predictors of COVID-19 severity: A literature review. Rev Med Virol. 2020; 31(1):1-10. PMC: 7855377. DOI: 10.1002/rmv.2146. View

17.

Artero A, Madrazo M, Fernandez-Garces M, Muino Miguez A, Garcia A, Crestelo Vieitez A . Severity Scores in COVID-19 Pneumonia: a Multicenter, Retrospective, Cohort Study. J Gen Intern Med. 2021; 36(5):1338-1345. PMC: 7878165. DOI: 10.1007/s11606-021-06626-7. View

18.

de Souza R, Mhatre S, Qayyumi B, Chitkara G, Madke T, Joshi M . Clinical course and outcome of patients with COVID-19 in Mumbai City: an observational study. BMJ Open. 2021; 11(5):e042943. PMC: 8103559. DOI: 10.1136/bmjopen-2020-042943. View

19.

Capelastegui A, Espana P, Quintana J, Areitio I, Gorordo I, Egurrola M . Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J. 2006; 27(1):151-7. DOI: 10.1183/09031936.06.00062505. View

20.

Tang M, Yu X, Huang J, Gao J, Cen F, Xiao Q . Clinical diagnosis of severe COVID-19: A derivation and validation of a prediction rule. World J Clin Cases. 2021; 9(13):2994-3007. PMC: 8080753. DOI: 10.12998/wjcc.v9.i13.2994. View