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Abstract
Introduction The COVID-19 pandemic is ongoing, yet, due to the lack of a COVID-19-specific tool, clinicians must use pre-existing illness severity scores for initial prognostication. However, the validity of such scores in COVID-19 is unknown.
Methods The North West Collaborative Organisation for Respiratory Research performed a multicentre prospective evaluation of adult patients admitted to the hospital with confirmed COVID-19 during a 2-week period in April 2020. Clinical variables measured as part of usual care at presentation to the hospital were recorded, including the Confusion, Urea, Respiratory Rate, Blood Pressure and Age Above or Below 65 Years (CURB-65), National Early Warning Score 2 (NEWS2) and Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) scores. The primary outcome of interest was 30-day mortality.
Results Data were collected for 830 people with COVID-19 admitted across seven hospitals. By 30 days, a total of 300 (36.1%) had died and 142 (17.1%) had been in the intensive care unit. All scores underestimated mortality compared with pre-COVID-19 cohorts, and overall prognostic performance was generally poor. Among the ‘low-risk’ categories (CURB-65 score<2, NEWS2<5 and qSOFA score<2), 30-day mortality was 16.7%, 32.9% and 21.4%, respectively. NEWS2≥5 had a negative predictive value of 98% for early mortality. Multivariable logistic regression identified features of respiratory compromise rather than circulatory collapse as most relevant prognostic variables.
Conclusion In the setting of COVID-19, existing prognostic scores underestimated risk. The design of new prognostic tools should focus on features of respiratory compromise rather than circulatory collapse. We provide a baseline set of variables which are relevant to COVID-19 outcomes and may be used as a basis for developing a bespoke COVID-19 prognostication tool.
- viral infection
- pneumonia
- respiratory infection
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Footnotes
PB and FF are joint first authors.
Twitter @Freddy_Frost1
PB and FF contributed equally.
Collaborators North West Collaborative Organisation for Respiratory Research collaborators: Mahin Ahmad; Joshua Aigbirior, Alex Bull, Ruth Cade, Kate Grant, Charlotte King, Ayesha Kumar, Farheen Kutubuddin, Konstantinos Liatsikos, Muhammed Haris Mir, Eman Nasr, Laurence Pearmain, Rachel Penfold, Sarika Raghunath, Victoria Randles, Ryan Robinson and Ran Wang.
Contributors Conception and design: FF, PB and DGW. Clinical data collection: FF, PB and North West Collaborative Organisation for Respiratory Research collaborators. Analysis and interpretation: KT, FF, PB and DGW. Manuscript preparation: FF, PB and DGW, with review by KT. Clinical governance and academic supervision: DGW.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Institutional approval for data collection and anonymised data collation was obtained from all sites and was a combination of Caldicott guardian and research/audit committee approvals.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request made to the corresponding author.
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