Evaluating the CURB-65 score for in-hospital mortality prediction in COVID-19 patients: insights into dysglycaemia
Introduction 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...
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BMJ Publishing Group
2024-12-01
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| Series: | BMJ Public Health |
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| author | Farzahna Mohamed Frederick Raal Aletta Millen Brent A Prim Jarrod Zamparini Ismail Sikander Kalla |
| author_facet | Farzahna Mohamed Frederick Raal Aletta Millen Brent A Prim Jarrod Zamparini Ismail Sikander Kalla |
| author_sort | Farzahna Mohamed |
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| description | Introduction 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.Design 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.Results 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.Conclusions 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. |
| format | Article |
| id | doaj-art-cdbd5f56132d4e51bbc16afe3d3a36ed |
| institution | DOAJ |
| issn | 2753-4294 |
| language | English |
| publishDate | 2024-12-01 |
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| spelling | doaj-art-cdbd5f56132d4e51bbc16afe3d3a36ed2025-08-20T02:40:17ZengBMJ Publishing GroupBMJ Public Health2753-42942024-12-012210.1136/bmjph-2024-001291Evaluating the CURB-65 score for in-hospital mortality prediction in COVID-19 patients: insights into dysglycaemiaFarzahna Mohamed0Frederick Raal1Aletta Millen2Brent A Prim3Jarrod Zamparini4Ismail Sikander Kalla5consultant endocrinologistprofessor and head, division of endocrinology1University of the Witwatersrand, Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, Johannesburg, South AfricaInternal Medicine, University of the Witwatersrand, Johannesburg, South AfricaInternal Medicine, University of the Witwatersrand, Johannesburg, South AfricaInternal Medicine, University of the Witwatersrand, Johannesburg, South AfricaIntroduction 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.Design 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.Results 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.Conclusions 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.https://bmjpublichealth.bmj.com/content/2/2/e001291.full |
| spellingShingle | Farzahna Mohamed Frederick Raal Aletta Millen Brent A Prim Jarrod Zamparini Ismail Sikander Kalla Evaluating the CURB-65 score for in-hospital mortality prediction in COVID-19 patients: insights into dysglycaemia BMJ Public Health |
| title | Evaluating the CURB-65 score for in-hospital mortality prediction in COVID-19 patients: insights into dysglycaemia |
| title_full | Evaluating the CURB-65 score for in-hospital mortality prediction in COVID-19 patients: insights into dysglycaemia |
| title_fullStr | Evaluating the CURB-65 score for in-hospital mortality prediction in COVID-19 patients: insights into dysglycaemia |
| title_full_unstemmed | Evaluating the CURB-65 score for in-hospital mortality prediction in COVID-19 patients: insights into dysglycaemia |
| title_short | Evaluating the CURB-65 score for in-hospital mortality prediction in COVID-19 patients: insights into dysglycaemia |
| title_sort | evaluating the curb 65 score for in hospital mortality prediction in covid 19 patients insights into dysglycaemia |
| url | https://bmjpublichealth.bmj.com/content/2/2/e001291.full |
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