Mohamed Farzahna, Prim Brent A, Zamparini Jarrod, Millen Aletta, Raal Frederick, Kalla Ismail Sikander
Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa.
School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
BMJ Public Health. 2024 Dec 22;2(2):e001291. doi: 10.1136/bmjph-2024-001291. eCollection 2024 Dec.
While the CURB-65 score predicts mortality in community-acquired pneumonia (CAP), its performance in COVID-19 CAP is suboptimal. Hyperglycaemia correlates with an increased mortality in COVID-19. This analysis aims to enhance predictive accuracy for in-hospital mortality among COVID-19 patients by augmenting the CURB-65 score with objective variables, including markers of dysglycaemia.
A single-centre retrospective observational analysis assessed the effectiveness of the CURB-65 score in predicting in-hospital mortality among adult patients with moderate to severe COVID-19 from March to September 2020. Using a binary logistic regression model, two extended CURB-65 scores which include markers of dysglycemia are proposed to enhance the predictive capability of the CURB-65 score for in-hospital mortality.
Among 517 patients admitted, 117 (22.6%) died. Using the CURB-65 score, 393 patients (76%) were classified as low risk, 91 (17.6%) as medium risk and 33 (6.4%) as high risk. 37 patients were diagnosed with new-onset dysglycaemia, of which 22 (59.5%) died (p<0.001). Of those with dysglycaemia who died, 41% and 23% were classified as low risk and high risk using the CURB-65 score. The CURB-65 score demonstrated a modest area under the receiver operator characteristic curve (AUC) of 0.75 (95% CI 0.70 to 0.81) for in-hospital mortality in COVID-19 CAP. An Extended CURB-65 Score 1, incorporating an admission of fasting plasma glucose (FPG) and neutrophil to lymphocyte ratio, showed improved prognostic performance with an AUC of 0.80 (95% CI 0.76 to 0.85). When lactate and lactate dehydrogenase were added to these parameters (Extended CURB-65 Score 2), the AUC was 0.82 (95% CI 0.78 to 0.86). The integrated discrimination index showed an 11% and 24% higher discrimination slope when using the Extended CURB-65 Scores 1 and 2, respectively.
The addition of common biochemical parameters including an admission FPG enhances the prognostic performance of CURB-65 for in-hospital mortality among patients with COVID-19.
虽然CURB-65评分可预测社区获得性肺炎（CAP）的死亡率，但其在新型冠状病毒肺炎合并社区获得性肺炎（COVID-19 CAP）中的表现并不理想。高血糖与COVID-19患者死亡率增加相关。本分析旨在通过将包括血糖异常标志物在内的客观变量纳入CURB-65评分，提高COVID-19患者院内死亡率的预测准确性。
一项单中心回顾性观察分析评估了CURB-65评分在预测2020年3月至9月中重度COVID-19成年患者院内死亡率方面的有效性。使用二元逻辑回归模型，提出了两个扩展的CURB-65评分，其中包括血糖异常标志物，以增强CURB-65评分对院内死亡率的预测能力。
在517例入院患者中，117例（22.6%）死亡。使用CURB-65评分，393例患者（76%）被归类为低风险，91例（17.6%）为中度风险，33例（6.4%）为高风险。37例患者被诊断为新发血糖异常，其中22例（59.5%）死亡（p<0.001）。在死于血糖异常的患者中，使用CURB-65评分时，41%和23%被归类为低风险和高风险。CURB-65评分在COVID-19 CAP患者院内死亡率的受试者工作特征曲线（AUC）下面积为0.75（95%CI 0.70至0.81），表现一般。纳入空腹血糖（FPG）和中性粒细胞与淋巴细胞比值的扩展CURB-65评分1显示预后性能有所改善，AUC为0.80（95%CI 0.76至0.85）。当将乳酸和乳酸脱氢酶添加到这些参数中（扩展CURB-65评分2）时，AUC为0.82（95%CI 0.78至0.86）。综合判别指数显示，使用扩展CURB-65评分1和2时，判别斜率分别高出11%和24%。
添加包括入院FPG在内的常见生化参数可提高CURB-65对COVID-19患者院内死亡率的预后评估性能。
